Provider Demographics
NPI:1104850841
Name:GAROFALO, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:GAROFALO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:847 OLD LANCASTER ROAD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3203
Mailing Address - Country:US
Mailing Address - Phone:610-527-1290
Mailing Address - Fax:610-527-0979
Practice Address - Street 1:847 OLD LANCASTER ROAD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3203
Practice Address - Country:US
Practice Address - Phone:610-527-1290
Practice Address - Fax:610-527-0979
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036813L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0048664000OtherBCBS
0048664000OtherBCBS
GA151450Medicare ID - Type Unspecified