Provider Demographics
NPI:1730394099
Name:FLOOD, JEAN (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:FLOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 VALLEY FORGE RD
Mailing Address - Street 2:SUITE 35/36
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2676
Mailing Address - Country:US
Mailing Address - Phone:610-933-1688
Mailing Address - Fax:610-983-0698
Practice Address - Street 1:1220 VALLEY FORGE RD
Practice Address - Street 2:SUITE 35/36
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2676
Practice Address - Country:US
Practice Address - Phone:610-933-1688
Practice Address - Fax:610-983-0698
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055974-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0968525-03Medicaid
PA0968525-03Medicaid