Provider Demographics
NPI:1811557580
Name:MCKEON, JOHN OWEN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:OWEN
Last Name:MCKEON
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 1:245 N 15TH ST FL MS 427
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1198
Mailing Address - Country:US
Mailing Address - Phone:215-762-7916
Mailing Address - Fax:
Practice Address - Street 1:245 N 15TH ST FL MS 427
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1198
Practice Address - Country:US
Practice Address - Phone:215-762-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT019312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine