Provider Demographics
NPI:1871800607
Name:SOUCHET, JESSICA L (DO)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:SOUCHET
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1648 HUNTINGDON PIKE
Mailing Address - Street 2:MEDICAL STAFF OFFICE 1ST FLR
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3910
Mailing Address - Country:US
Mailing Address - Phone:215-938-3450
Mailing Address - Fax:215-938-3829
Practice Address - Street 1:1844 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4582
Practice Address - Country:US
Practice Address - Phone:215-357-4066
Practice Address - Fax:215-364-2572
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY267402207Q00000X
PAOS020439207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03650635Medicaid
NYA400145149Medicare PIN