Individual
CARISSA ROSE JACKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3550 MARKET ST, PHILADELPHIA, PA 19104
(215) 590-1000
(215) 590-4844
Mailing address
100 PENN SQUARE EAST, 9TH FLOOR NORTH TOWER, PHILADELPHIA, PA 19107
(267) 425-9200
(267) 425-9299
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD448416
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1032348390001
—
PA
Enumeration date
04/10/2010
Last updated
11/21/2018
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