Provider Demographics
NPI:1598784324
Name:CURTIS, JACQUE (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUE
Middle Name:
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 E OLNEY AVE STE 40
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2421
Mailing Address - Country:US
Mailing Address - Phone:215-456-1825
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:7131 FRANKFORD AVE # 39
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1008
Practice Address - Country:US
Practice Address - Phone:215-332-4164
Practice Address - Fax:215-332-9638
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD055881L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015624800014Medicaid
PA0015624800005Medicaid
PA0015624800005Medicaid