Provider Demographics
NPI:1932311305
Name:LANDRY, JONATHAN PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PHILIP
Last Name:LANDRY
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 1:2255 MONTROSE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2529
Mailing Address - Country:US
Mailing Address - Phone:215-300-3265
Mailing Address - Fax:
Practice Address - Street 1:2800 MAIN ST
Practice Address - Street 2:ST VINCENTS MEDICAL CENTER: EMERGENCY DEPARTMENT
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-0000
Practice Address - Country:US
Practice Address - Phone:215-300-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437932207P00000X
NJ25MA08771900207P00000X
DCMD041706207P00000X
CT053630207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine