Individual
JOHNY ELIE FARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 E LANCASTER AVE, MOB WEST SUITE 135, WYNNEWOOD, PA 19096-3435
(484) 476-1190
Mailing address
3803 W CHESTER PIKE STE 160, NEWTOWN SQUARE, PA 19073-2336
(484) 337-1632
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD484433
PA
207RR0500X
Rheumatology Physician
Primary
MD484433
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2019
Last updated
08/07/2024
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