Provider Demographics
NPI:1699920504
Name:ENGEL, JEANNE FABIAN (DO)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:FABIAN
Last Name:ENGEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1001 S GEORGE ST
Mailing Address - Street 2:4TH FLR
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3676
Mailing Address - Country:US
Mailing Address - Phone:717-851-4005
Mailing Address - Fax:717-812-2495
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:4TH FLR
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-4005
Practice Address - Fax:717-812-2495
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2014-01011207Q00000X
NY250633207Q00000X
PAOS014893207Q00000X
IN02003849A207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102448133Medicaid
NC1699920504Medicaid
SCNC2342Medicaid
NCNCM909DMedicare PIN
PA219988FLTMedicare PIN
PA102448133Medicaid
NCNCM909BMedicare PIN
NCNCM909AMedicare PIN