Healthcare Provider Details

I. General information

NPI: 1780689794
Provider Name (Legal Business Name): JOHN BLANNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 LANSDOWNE AVE STE 3001
DARBY PA
19023-1330
US

IV. Provider business mailing address

1503 LANSDOWNE AVE STE 3001
DARBY PA
19023-1330
US

V. Phone/Fax

Practice location:
  • Phone: 610-586-4100
  • Fax: 610-586-4114
Mailing address:
  • Phone: 610-586-4100
  • Fax: 610-586-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD019872E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: