Provider Demographics
NPI:1134144660
Name:JOHR, CHADWICK R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:R
Last Name:JOHR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3737 MARKET ST
Mailing Address - Street 2:FL 8
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5545
Mailing Address - Country:US
Mailing Address - Phone:215-662-4333
Mailing Address - Fax:215-349-8900
Practice Address - Street 1:3910 POWELTON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2692
Practice Address - Country:US
Practice Address - Phone:215-662-4333
Practice Address - Fax:215-349-8900
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD428938207RR0500X, 207RR0500X
IA37201208000000X, 207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0923206Medicare PIN
IAP00778222Medicare PIN