Provider Demographics
NPI:1427086412
Name:SURRY, JOHN HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOWARD
Last Name:SURRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758952
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 S SPORTING HILL RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3058
Practice Address - Country:US
Practice Address - Phone:717-943-1781
Practice Address - Fax:717-943-1782
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016659E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA29946OtherJOHNS HOPKINS
PA44745OtherGEISINGER
PA000645696Medicaid
PA4256943OtherAETNA
MD606735OtherCAREFIRST MD BCBS
PA0038347000OtherAMERIHEALTH 65 PA
PA091145OtherHIGHMARK BLUE SHIELD
PA44745OtherGEISINGER
PA0038347000OtherAMERIHEALTH 65 PA
PA091145YJSMedicare UPIN
PA225373YEBK - 213827Medicare PIN
PA080156854Medicare PIN
PA125308YJOMedicare PIN