Provider Demographics
NPI:1154719250
Name:VERSHVOVSKY, JENNIE (MD)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:VERSHVOVSKY
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 1:200 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5104
Mailing Address - Country:US
Mailing Address - Phone:302-577-3420
Mailing Address - Fax:302-577-3416
Practice Address - Street 1:200 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-5104
Practice Address - Country:US
Practice Address - Phone:302-577-3420
Practice Address - Fax:302-577-3416
Is Sole Proprietor?:No
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007039207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology