Individual
JESSICA BLAIR DIJULIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, MMS, PA-C
Contact information
Practice address
833 CHESTNUT ST, PHILADELPHIA, PA 19107-4414
(484) 951-4055
Mailing address
833 CHESTNUT ST STE 740, PHILADELPHIA, PA 19107-4409
(215) 955-6680
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MA060109
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA060109
STATE BOARD OF MEDICINE LICENSE
PA
01
—
OA004607
STATE BOARD OF OSTEOPATHIC MEDICINE LICENSE
PA
Enumeration date
09/14/2018
Last updated
07/14/2020
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