Provider Demographics
NPI:1487618617
Name:CLAVES, JENNIFER L (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CLAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 SPROUL RD
Mailing Address - Street 2:SUITE 625
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3524
Mailing Address - Country:US
Mailing Address - Phone:610-325-0309
Mailing Address - Fax:610-325-0459
Practice Address - Street 1:1991 SPROUL RD
Practice Address - Street 2:SUITE 625
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3524
Practice Address - Country:US
Practice Address - Phone:610-325-0309
Practice Address - Fax:610-325-0459
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070231L207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H20290Medicare UPIN
H20290Medicare UPIN
PA039621HK1Medicare PIN
PA001807897Medicaid