Provider Demographics
NPI:1255476065
Name:JOHN F DEVINE, DO, PC
Entity Type:Organization
Organization Name:JOHN F DEVINE, DO, PC
Other - Org Name:SUSQUEHANNA MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-523-6770
Mailing Address - Street 1:115 FARLEY CIR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9252
Mailing Address - Country:US
Mailing Address - Phone:570-523-6770
Mailing Address - Fax:570-523-6773
Practice Address - Street 1:115 FARLEY CIR
Practice Address - Street 2:SUITE 107
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9252
Practice Address - Country:US
Practice Address - Phone:570-523-6770
Practice Address - Fax:570-523-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008931L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015619840012Medicaid
PA0015619840012Medicaid
PAG20747Medicare UPIN