Jacquelyn Detweiler, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

OS009367L Issued in PA

Practice address

891 E Baltimore Pike
Kennett Square, PA 19348-1801

Phone

(610) 444-0113

Fax

(610) 444-0744

NPI assigned

Aug 12, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Children'S Hospital of Philadelphia

  • Pediatrics Physician
  • Erdenheim, PA
  • NPI 1831262732
  NPD (past)

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433376000000",
    "number": "1396747994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "891 E BALTIMORE PIKE",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193481801",
            "telephone_number": "610-444-0113",
            "fax_number": "610-444-0744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "891 E BALTIMORE PIKE",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193481801",
            "telephone_number": "610-444-0113",
            "fax_number": "610-444-0744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETWEILER",
        "first_name": "JACQUELYN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-12",
        "last_updated": "2015-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MB07128100",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "OS009367L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8655707",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy Ann Davison, FNP-C
• Melanie Dellert
• Sandra A Delligatti, PT
• Deron T. Kovac, D.M.D. & Brendan F. Mulligan, D.M.D.
• Angelica Desantis
• Andrea C Devries, LCSW
• Diakon Child Family & Community Ministries
• Diamond State Advisory, LLC
• Katherine Marie Diehl, COTA/L
• Elizabeth Difebo, PT, DPT

• Pediatrics Physician in Kennett Square, PA
• Providers in Kennett Square, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.