Individual
DR. JENNIFER M TY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1600 ROCKLAND ROAD, WILMINGTON, DE 19803-3607
(302) 651-5723
(302) 651-4945
Mailing address
PO BOX 191, PROVIDER ENROLLMENT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
C10008887
DE
207XP3100X
Pediatric Orthopaedic Surgery Physician
227564
MA
2080S0010X
Pediatric Sports Medicine Physician
MD435461
PA
Other
Enumeration date
10/19/2006
Last updated
02/17/2012
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