Provider Demographics
NPI:1194754762
Name:DUPRE, JENNIFER LEE (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:DUPRE
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:PO BOX 789967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9967
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:17 IRON BRIDGE DR STE 150
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2042
Practice Address - Country:US
Practice Address - Phone:484-622-6320
Practice Address - Fax:484-622-6337
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS011903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063263Medicare PIN
PAH71655Medicare UPIN