Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD024448E | PA |
NPI | 1124020680 |
---|---|
Provider Name | John J Deeney |
First Address | Philadelphia, PA 19154-1201 |
Second Address | Meadowbrook, PA 19046-8004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 01/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0010540240008 | (05) | PA |
B37269 | (02) |