Provider Demographics
NPI:1285664516
Name:GEOVJIAN, JOHN H (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:GEOVJIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1004
Mailing Address - Country:US
Mailing Address - Phone:610-622-2818
Mailing Address - Fax:610-622-2360
Practice Address - Street 1:600 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1004
Practice Address - Country:US
Practice Address - Phone:610-622-2818
Practice Address - Fax:610-622-2360
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003101-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT82302Medicare UPIN