Provider Demographics
NPI:1386081461
Name:WITHELDER, JEFFREY R (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:WITHELDER
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Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:925 CHESTNUT ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:267-339-3500
Practice Address - Fax:215-503-0580
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054915363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical