Provider Demographics
NPI:1831109206
Name:POKORNY, JOHN HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:POKORNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IVAN
Other - Middle Name:JINDRICH
Other - Last Name:POKORNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1245 HIGHLAND AVE
Mailing Address - Street 2:SUITE G-05
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3714
Mailing Address - Country:US
Mailing Address - Phone:215-884-2880
Mailing Address - Fax:215-885-9768
Practice Address - Street 1:1245 HIGHLAND AVE
Practice Address - Street 2:SUITE G-05
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3714
Practice Address - Country:US
Practice Address - Phone:215-884-2880
Practice Address - Fax:215-885-9768
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-047352L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0802867000OtherAMERIHEALTH
PA777940OtherHIGHMARK BLUE SHIELD
PA00802867000OtherINDEPENDENCE BLUE CROSS
PA0802867000OtherKEYSTONE
PA777940Medicare ID - Type Unspecified
PAE61893Medicare UPIN