Individual
JACQUELINE K GENOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1503 LANSDOWNE AVE, STE 3002 LANSDOWNE PARK PEDIATRICS, DARBY, PA 19023
(610) 237-4995
(610) 237-7311
Mailing address
1503 LANSDOWNE AVE, STE 3002, DARBY, PA 19023
(610) 237-4995
(610) 237-7311
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD068318L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008879940001
—
PA
01
—
2258915000
IBC
—
01
—
30008552
KMHP
—
01
—
3248072
AETNA
—
01
—
5611580
CIGNA
—
01
—
GE1579643
HIGHMARK BS
—
Enumeration date
02/23/2006
Last updated
07/03/2011
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