Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MD461642 | PA |
NPI | 1316350366 |
---|---|
Provider Name | Charlene Jones |
First Address | Newtown, PA 18940-1873 |
Second Address | Springfield, PA 19064-2800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2014 |
Last Update Date | 25/05/2021 |