Provider Demographics
NPI:1386203743
Name:SKIDMORE, FLYNN (MED)
Entity Type:Individual
Prefix:
First Name:FLYNN
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 E PASSYUNK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2924
Mailing Address - Country:US
Mailing Address - Phone:917-215-9758
Mailing Address - Fax:
Practice Address - Street 1:704 CATHARINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-2812
Practice Address - Country:US
Practice Address - Phone:917-215-9758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health