Provider Demographics
NPI:1285609511
Name:KNEELAND, JOHN B (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:KNEELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:801 SPRUCE ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5701
Mailing Address - Country:US
Mailing Address - Phone:215-829-6079
Mailing Address - Fax:215-829-7482
Practice Address - Street 1:801 SPRUCE ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5701
Practice Address - Country:US
Practice Address - Phone:215-829-6741
Practice Address - Fax:215-829-7547
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041715L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD99504Medicare UPIN