Provider Demographics
NPI:1538195284
Name:DIABO, JENNIFER DANA (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DANA
Last Name:DIABO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1609 ASHBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2534
Mailing Address - Country:US
Mailing Address - Phone:215-432-6313
Mailing Address - Fax:215-423-6743
Practice Address - Street 1:2346 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4434
Practice Address - Country:US
Practice Address - Phone:215-423-1011
Practice Address - Fax:215-423-6743
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD417182208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019068950003Medicaid
PAH73697Medicare UPIN
PA0019068950003Medicaid