Provider Demographics
NPI:1871800466
Name:PANGANIBAN, JENNIFER ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ALBERTO
Last Name:PANGANIBAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 PENN SQUARE EAST, 9TH FL NORTH TOWER
Mailing Address - Street 2:CHCA GASTRO & NUTRITION
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHCA GASTRO & NUTRITION
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-3247
Practice Address - Fax:215-590-3606
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2016-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN13578208000000X
PAMD 4546922080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics