Healthcare Provider Details

I. General information

NPI: 1730367525
Provider Name (Legal Business Name): JASON S HEARN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 JOHN ROBERT THOMAS DR
EXTON PA
19341-2656
US

IV. Provider business mailing address

142 JOHN ROBERT THOMAS DR
EXTON PA
19341-2656
US

V. Phone/Fax

Practice location:
  • Phone: 610-524-3338
  • Fax: 610-524-1441
Mailing address:
  • Phone: 610-524-3338
  • Fax: 610-524-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005878
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: