Healthcare Provider Details

I. General information

NPI: 1861997025
Provider Name (Legal Business Name): JOHN ALEXANDER DUFFY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEC DUFFY MD

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberMT235940
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberMT235940
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: