Healthcare Provider Details

I. General information

NPI: 1255422135
Provider Name (Legal Business Name): FERDINAND ANDRES ACZON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 N 5TH ST
PHILADELPHIA PA
19133-2701
US

IV. Provider business mailing address

204 SUMMIT RD
MOUNT LAUREL NJ
08054-4748
US

V. Phone/Fax

Practice location:
  • Phone: 215-739-8777
  • Fax: 215-739-9016
Mailing address:
  • Phone: 215-739-8777
  • Fax: 215-739-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD08982L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: