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General NPI Number Information
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NPI Number | 1164403697
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Entity Type | Individual
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Provider Name | JOHN MICHAEL FANELLY DPM
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Gender | Male
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 6650 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19135-2540
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Country | US
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Telephone | 215-335-3338
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Fax | 215-335-9844
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Provider Business Mailing Address
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Address Line | 6650 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19135-2540
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Country | US
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Telephone | 215-335-3338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC002579L
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License Number State | PA
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