Individual
ELLEN C JANTZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
34TH STREET & CIVIC CENTER BLVD, SUITE 9329, PHILADELPHIA, PA 19104
(215) 590-1858
(215) 590-1415
Mailing address
100 E PENN SQ, THE WANAMAKER BUILDING, 9TH FLOOR, PHILADELPHIA, PA 19107-3323
(267) 425-9300
(267) 425-9331
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD028119E
PA
207LP3000X
Pediatric Anesthesiology Physician
Primary
MD028119E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009399530
—
PA
01
—
212585EJL
MEDICARE PTAN
PA
Enumeration date
08/19/2006
Last updated
04/11/2013
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