Provider Demographics
NPI:1558353722
Name:TUMASZ, JOHN VINCENT (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VINCENT
Last Name:TUMASZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 REVERE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1429
Mailing Address - Country:US
Mailing Address - Phone:215-338-8600
Mailing Address - Fax:215-338-8530
Practice Address - Street 1:7257 REVERE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1429
Practice Address - Country:US
Practice Address - Phone:215-338-8600
Practice Address - Fax:215-338-8530
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007142L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA614988Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
PAE51776Medicare UPIN