Healthcare Provider Details

I. General information

NPI: 1902898208
Provider Name (Legal Business Name): JOHN J FLANAGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 VALLEY FORGE RD SUITE 102
PHOENIXVILLE PA
19460-2691
US

IV. Provider business mailing address

1260 VALLEY FORGE RD SUITE 102
PHOENIXVILLE PA
19460-2691
US

V. Phone/Fax

Practice location:
  • Phone: 610-933-2444
  • Fax: 610-933-8320
Mailing address:
  • Phone: 610-933-2444
  • Fax: 610-933-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD043999L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: