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Individual

JACQUELYN DETWEILER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
891 E BALTIMORE PIKE, KENNETT SQUARE, PA 19348-1801
(610) 444-0113
(610) 444-0744
Mailing address
891 E BALTIMORE PIKE, KENNETT SQUARE, PA 19348-1801
(610) 444-0113
(610) 444-0744

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
25MB07128100
NJ
208000000X
Pediatrics Physician
Primary
OS009367L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8655707
NJ
Enumeration date
08/12/2005
Last updated
06/04/2015
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