Organization
JENNERSVILLE RADIOLOGY, P.C
Active
Organization
JENNERSVILLE RADIOLOGY, P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY CARMELLINI M.D. (HEAD DOCTOR)
(610) 372-4957
Entity
Organization
Contact information
Practice address
1015 W BALTIMORE PIKE, WEST GROVE, PA 19390-9459
(610) 372-4957
Mailing address
2 MERIDIAN BLVD, 2ND FLOOR, WYOMISSING, PA 19610-3202
(610) 372-4957
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019412210001
—
PA
Enumeration date
07/21/2005
Last updated
07/21/2022
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