Provider Demographics
NPI:1760472492
Name:FOBIA, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:FOBIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6964
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:501 S 54TH ST
Practice Address - Street 2:SUITE 227
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:215-748-9653
Practice Address - Fax:215-748-9667
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2008-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD021128208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4100588OtherAETNA OTHER
PA0009005560005Medicaid
PA1153304OtherKEYSTONE MERCY HEALTH PLA
PA1544375OtherBLUE SHIELD
PA0052566000OtherKEYSTONE HEALTH PLAN EAST
PA2610919OtherAETNA HMO
PAP00089661Medicare PIN
PA1153304OtherKEYSTONE MERCY HEALTH PLA
PA2610919OtherAETNA HMO
PA0009005560005Medicaid