Provider Demographics
NPI:1497705776
Name:DEVENNEY, JOHN E (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:DEVENNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 820137
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0137
Mailing Address - Country:US
Mailing Address - Phone:610-270-2352
Mailing Address - Fax:610-270-2358
Practice Address - Street 1:559 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4250
Practice Address - Country:US
Practice Address - Phone:484-622-0700
Practice Address - Fax:484-622-0643
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013519E2085N0700X, 2085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA066736OtherHIGHMARK BLUESHIELD
PA300040510OtherRRM
PA0070422201OtherAMERICHOICE
PA4339200OtherAETNA PPO
PA1030301OtherKEYSTONE MERCY HEALTHPLAN
PA350689OtherPHCS
PA2649708OtherAETNA HMO
PA6864183OtherCIGNA HMO/PPO
PA0007042220001Medicaid
PA0057272000OtherIBC - PC/KHPE
PA0057272000OtherAMERIHEALTH/INTERCOUNTY
PA0057272000OtherAMERIHEALTH/INTERCOUNTY
PA350689OtherPHCS