Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD065956L | PA |
NPI | 1043231053 |
---|---|
Provider Name | Dr. Jessy John |
First Address | Downingtown, PA 19335-4134 |
Second Address | Exton, PA 19341-2503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 08/07/2007 |