MEDICARE: DR. JOHN H. GEOVJIAN D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	SC003101-L	PA

General Provider Information

NPI Number	:	1285664516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN H. GEOVJIAN D.P.M.

Provider Business Mailing Address
First Line	:	600 MAGNOLIA AVE
Second Line	:
City	:	GLENOLDEN
State	:	PA
Zip	:	19036-1004
Country	:	US
Telephone Number	:	610-622-2818
Fax Number	:	610-622-2360

Provider Business Practice Location Address
First Line	:	600 MAGNOLIA AVE
Second Line	:
City	:	GLENOLDEN
State	:	PA
Zip	:	19036-1004
Country	:	US
Telephone Number	:	610-622-2818
Fax Number	:	610-622-2360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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