Individual
JONATHAN SCOTT BLIZZARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4190 CITY AVENUE, PHILADELPHIA, PA 19131
(215) 871-6690
Mailing address
4190 CITY AVENUE, PCOM, PHILADELPHIA, PA 19131
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MB10848100
NJ
Other
Enumeration date
03/07/2017
Last updated
09/08/2020
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