1568422848 NPI number — DR. DENNY JOHN MD

Table of content: DR. DENNY JOHN MD (NPI 1568422848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568422848 NPI number — DR. DENNY JOHN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHN
Provider First Name:
DENNY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568422848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 829641
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-9641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-370-5285
Provider Business Mailing Address Fax Number:
152-303-7252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
847 EASTON RD STE 2700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18976-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-345-0105
Provider Business Practice Location Address Fax Number:
215-345-0562
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MD067617L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001824664 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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