Basic Information
| Provider Information | |||||||||
| NPI: | 1851577571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDDY | ||||||||
| FirstName: | JARROD | ||||||||
| MiddleName: | T | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 829641 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191824732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6723705296 | ||||||||
| FaxNumber: | 2152303725 | ||||||||
| Practice Location | |||||||||
| Address1: | 595 W STATE ST | ||||||||
| Address2: | |||||||||
| City: | DOYLESTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189012554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153452885 | ||||||||
| FaxNumber: | 2153452552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2008 | ||||||||
| LastUpdateDate: | 02/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | OS014315 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | OS 014315 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10215146 | 05 | PA | MEDICAID |