Provider Demographics
NPI:1043251895
Name:JOHN T BANNON MD PA
Entity Type:Organization
Organization Name:JOHN T BANNON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-653-9377
Mailing Address - Street 1:141 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2739
Mailing Address - Country:US
Mailing Address - Phone:609-653-9377
Mailing Address - Fax:609-926-0476
Practice Address - Street 1:141 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2739
Practice Address - Country:US
Practice Address - Phone:609-653-9377
Practice Address - Fax:609-926-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C52719Medicare UPIN
NJ044384Medicare ID - Type Unspecified