Individual
DR. JOHN J DESTAFENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
915 OLD FERN HILL RD BLDG B STE 200, WEST CHESTER, PA 19380-4269
(610) 696-1230
(610) 696-2341
Mailing address
915 OLD FERN HILL RD BLDG B STE 200, WEST CHESTER, PA 19380-4269
(610) 696-1230
(610) 918-0803
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
2005-00363
NC
207W00000X
Ophthalmology Physician
Primary
MD431622
PA
207WX0108X
Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
MD431622
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019183240001
—
PA
05
—
5901401
—
NC
Enumeration date
10/16/2006
Last updated
10/09/2020
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