Individual
MARIELL L JESSUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3400 CIVIC CENTER BOULEVARD, EAST PAVILION, 2ND FLOOR, PHILADELPHIA, PA 19104-4306
(215) 615-4949
(215) 615-0829
Mailing address
3400 CIVIC CENTER BOULEVARD, EAST PAVILLION, 2ND FLOOR, PHILADELPHIA, PA 19104-4306
(215) 615-4949
(215) 615-0829
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD020586E
PA
207RC0000X
Cardiovascular Disease Physician
Primary
MD020586E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010720780010
—
PA
Enumeration date
07/04/2006
Last updated
04/04/2012
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