Provider Demographics
NPI:1316350366
Name:JONES, CHARLENE (MD, MPH)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:STE 1360
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:302-320-9440
Mailing Address - Fax:
Practice Address - Street 1:1001 BALTIMORE PIKE STE 14LL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2800
Practice Address - Country:US
Practice Address - Phone:610-690-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00243192080S0010X
PAMD4616422080S0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine