Provider Demographics
NPI:1780970442
Name:DESALVO, JESSICA L (DO)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:DESALVO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1528 WALNUT ST STE 950
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3628
Mailing Address - Country:US
Mailing Address - Phone:267-273-1196
Mailing Address - Fax:267-273-1193
Practice Address - Street 1:1528 WALNUT ST STE 950
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3628
Practice Address - Country:US
Practice Address - Phone:267-273-1196
Practice Address - Fax:267-273-1193
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT013994207R00000X
PAOS016649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine