Provider Demographics
NPI:1447546338
Name:KOHL, JACQUELINE ELYSE (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ELYSE
Last Name:KOHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2300 COMPUTER RD STE E25
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1737
Mailing Address - Country:US
Mailing Address - Phone:215-366-1160
Mailing Address - Fax:215-366-1141
Practice Address - Street 1:2300 COMPUTER RD STE E25
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1737
Practice Address - Country:US
Practice Address - Phone:215-366-1160
Practice Address - Fax:215-366-1141
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD449439207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology