Individual
JOHN WALTER ENTWISTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 WALNUT ST, MOB BLDG., SUITE 500, PHILADELPHIA, PA 19107-5563
(215) 955-6750
(215) 923-8222
Mailing address
1100 WALNUT ST, MOB BLDG., SUITE 500, PHILADELPHIA, PA 19107-5563
(215) 955-6750
(215) 923-8222
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MD067034L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001851572
—
PA
05
—
8566208
—
NJ
Enumeration date
06/13/2006
Last updated
11/01/2012
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