Provider Demographics
NPI:1659580348
Name:SYMONS, JOHN TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TAYLOR
Last Name:SYMONS
Suffix:
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:PO BOX B
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16693
Mailing Address - Country:US
Mailing Address - Phone:814-832-2131
Mailing Address - Fax:814-832-1133
Practice Address - Street 1:1 NEW BEGINNINGS ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:PA
Practice Address - Zip Code:16693
Practice Address - Country:US
Practice Address - Phone:814-832-2131
Practice Address - Fax:814-832-2133
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2008-06-02
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-06-02
Provider Licenses
StateLicense IDTaxonomies
PAMD023792E207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106082Medicaid
PA106082Medicaid