Provider Demographics
NPI:1346266863
Name:DEFRATE, JOHN AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:AUSTIN
Last Name:DEFRATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ROSE ANN LN
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-8924
Mailing Address - Country:US
Mailing Address - Phone:302-328-3330
Mailing Address - Fax:302-328-9336
Practice Address - Street 1:575 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4606
Practice Address - Country:US
Practice Address - Phone:302-328-3330
Practice Address - Fax:302-328-9336
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECL00051482084N0400X
PAMD061195L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD061195LOtherTAX ID NUMBER
DECL0005148OtherTAX ID NUMBER
DECL0005148OtherTAX ID NUMBER
DE020233C60Medicare PIN