Healthcare Provider Details

I. General information

NPI: 1760986665
Provider Name (Legal Business Name): JOHN DON PAPPAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6673 GERMANTOWN AVE
PHILADELPHIA PA
19119-2252
US

IV. Provider business mailing address

6673 GERMANTOWN AVE
PHILADELPHIA PA
19119-2252
US

V. Phone/Fax

Practice location:
  • Phone: 215-247-2996
  • Fax: 215-247-7504
Mailing address:
  • Phone: 215-247-2996
  • Fax: 215-247-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD474186
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: