Provider Demographics
NPI:1831255793
Name:JACKSON, OKSANA (MD)
Entity type:Individual
Prefix:
First Name:OKSANA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 EAST PENN SQUARE
Mailing Address - Street 2:THE WANAMAKER BUILDING 9TH FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9538
Mailing Address - Fax:267-425-9552
Practice Address - Street 1:34TH & CIVIC CENTER BLVD
Practice Address - Street 2:CHILDRENS HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-590-2208
Practice Address - Fax:215-590-2496
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-04-11
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Provider Licenses
StateLicense IDTaxonomies
PAMD424308208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102095848-0001Medicaid
PA176826J5LMedicare UPIN