Provider Demographics
NPI:1104023316
Name:HEIMALL, JENNIFER REBECCA (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:REBECCA
Last Name:HEIMALL
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9234
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3550 MARKET ST FL 3
Practice Address - Street 2:CHILDRENS HOSPITAL OF PHILADELPHIA - ALLERGY AND IMMUN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3365
Practice Address - Country:US
Practice Address - Phone:215-590-2549
Practice Address - Fax:215-590-4529
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD440044207K00000X, 208000000X, 2080P0201X
NJ25MA07835700207RA0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics