Dr John M Fanning, DO | |
8 Morton Ave, Suite 303, Ridley Park, PA 19078-2210 | |
(610) 595-6850 | |
(610) 595-6892 |
Full Name | Dr John M Fanning |
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Gender | Male |
Speciality | Family Medicine |
Location | 8 Morton Ave, Ridley Park, Pennsylvania |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1053494435 | NPI | - | NPPES |
001454661 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | OS003967L (Pennsylvania) | Primary |
Entity Name | Prospect Health Access Network Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1568819084 PECOS PAC ID: 5698065142 Enrollment ID: O20160613000737 |
Mailing Address | Practice Location Address |
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Dr John M Fanning, DO 8 Morton Ave, Suite 303, Ridley Park, PA 19078-2210 Ph: (610) 595-6850 | Dr John M Fanning, DO 8 Morton Ave, Suite 303, Ridley Park, PA 19078-2210 Ph: (610) 595-6850 |
Ellen K Boyda, CRNP Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 3 E Ridley Ave, Ridley Park, PA 19078 Phone: 610-532-8777 Fax: 610-532-1129 | |
Dr. John R Traverso, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 8 Morton Ave, Ridley Park, PA 19078 Phone: 610-595-6850 Fax: 610-595-6892 | |
Dr. David Raymond Kalodner, D.O. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 100 E Chester Pike, Ridley Park, PA 19078 Phone: 610-521-3333 Fax: 610-521-2263 |