Provider Demographics
NPI:1558333583
Name:NANSTEEL, JOHN F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:NANSTEEL
Suffix:JR
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 1:300 E LANCASTER AVE
Mailing Address - Street 2:SUITE 304, WYNNEWOOD HOUSE
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2139
Mailing Address - Country:US
Mailing Address - Phone:610-642-2002
Mailing Address - Fax:610-642-7607
Practice Address - Street 1:300 E LANCASTER AVE
Practice Address - Street 2:SUITE 304, WYNNEWOOD HOUSE
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2139
Practice Address - Country:US
Practice Address - Phone:610-642-2002
Practice Address - Fax:610-642-7607
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018441E207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMAIN LINE HEALTHCARE
PA000763751Medicaid
PA232359401OtherMAIN LINE HEALTHCARE
C28288Medicare UPIN