Provider Demographics
NPI:1477554541
Name:SIMELARO, JOHN P (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:SIMELARO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4190 CITY AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1626
Mailing Address - Country:US
Mailing Address - Phone:215-871-6337
Mailing Address - Fax:215-871-6347
Practice Address - Street 1:4190 CITY AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1626
Practice Address - Country:US
Practice Address - Phone:215-871-6337
Practice Address - Fax:215-871-6347
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS002871L207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000701801Medicaid
PA193076JSHMedicare PIN
PA082140JSHMedicare PIN
PA082140JTPMedicare PIN
PA000701801Medicaid