NPIMap

Individual provider Active NPI

Jackeline Iacovella, MD

  • Infectious Disease Physician
  • Wynnewood, PA
National Provider Identifier
1174660195
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
MD057529L Issued in PA
Practice address
100 E Lancaster Ave Ste 467
Wynnewood, PA 19096-3434
Phone
(610) 896-0210
Fax
(610) 896-5101
NPI assigned
Jan 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X MD057529L PA Primary

Addresses

Primary practice location

100 E Lancaster Ave Ste 467
Wynnewood, PA 19096-3434

Mailing address

100 E Lancaster Ave Ste 467
Wynnewood, PA 19096-3434
Phone (610) 896-0210

Other identifiers 1

IdentifierTypeStateIssuer
001792248MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040609000442 PA Practitioner - Infectious Disease 3971586223 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Delaware Valley I.D. Associates, P.C.Group PAC ID 2365421161, 11 clinicians

Practice addresses (Care Compare)

100 E Lancaster Ave
Suite 467
Wynnewood, PA 19096-3434
Phone (610) 896-0210

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD057529LPAMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Health Access Network, Inc. Current Accepting new patients
Prospect Health Access Network, Inc. Infectious Disease CurrentSince Jul 1, 2016 Accepting new patients
Delaware Valley I.D. Associates, P.C. Infectious Disease CurrentSince Jun 14, 2022 Accepting new patients
Prospect Health Access Network, Inc. CurrentSince Jul 1, 2016 Accepting new patients
West Florida Medical Center Clinic PA Past Accepting new patients
Prospect Health Access Network, Inc. Past Accepting new patients
Reading Professional Services Past Accepting new patients

Locations

1 Medical Center Blvd
Ste 301
Chester, PA 19013
Phone (610) 566-6744

1 Medical Center Blvd
Chester, PA 19013
Phone (610) 447-6666

2100 Keystone Ave
Ste 406
Drexel Hill, PA 19026
Phone (610) 619-7475

2100 Keystone Ave
Ste 506
Drexel Hill, PA 19026
Phone (610) 394-9414

100 W Sproul Rd
Ste 123
Springfield, PA 19064
Phone (610) 619-8281

100 E Lancaster Ave
Wynnewood, PA 19096
Phone (484) 337-3583

100 E Lancaster Ave
Ste 164
Wynnewood, PA 19096
Phone (610) 896-0210

100 E Lancaster Ave
Ste 467
Wynnewood, PA 19096
Phone (610) 896-0210

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1174660195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE STE 467",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963434",
            "telephone_number": "610-896-0210",
            "fax_number": "610-896-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E LANCASTER AVE STE 467",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190963434",
            "telephone_number": "610-896-0210",
            "fax_number": "610-896-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IACOVELLA",
        "first_name": "JACKELINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "PA",
            "license": "MD057529L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001792248",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wynnewood, PA

Sources for this page

Verify at the official NPI Registry.