Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | MD045557L | PA |
N | 208000000X | Pediatrician | MD045557L | PA |
N | 2080P0203X | Pediatric Critical Care Doctor | MD045557L | PA |
NPI | 1164435822 |
---|---|
Provider Name | John J Mccloskey |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 11/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012542300 | (05) | PA |
082569EMD | MEDICARE PTAN CRITICAL CARE MEDICINE (01) | PA |
802314EJL | MEDICARE ANESTHESIA (01) | PA |
D78125 | (02) | PA |