Individual
SVETLANA DE JOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2135 E CHELTEN AVE, PHILA, PA 19138-2534
(215) 424-5365
(215) 424-5370
Mailing address
2500 S BROAD ST, PHILADELPHIA, PA 19145-4615
(215) 605-8096
(215) 424-5365
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
OA000517L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
044560JT9
MEDICARE IDENTIFICATION NUMBER
PA
Enumeration date
10/26/2006
Last updated
08/01/2016
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