Provider Demographics
NPI:1275532160
Name:ADDLEY, JOAN MUREEN (DO)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MUREEN
Last Name:ADDLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 UNIVERSITY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8125 STENTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-3530
Practice Address - Country:US
Practice Address - Phone:215-248-7560
Practice Address - Fax:215-248-7564
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010055L207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101305637Medicaid
PA026230Medicare ID - Type Unspecified
G90621Medicare UPIN