Provider Demographics
NPI:1013918572
Name:CHILDS, JOHN NORRIS III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NORRIS
Last Name:CHILDS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:432 W WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3715
Mailing Address - Country:US
Mailing Address - Phone:215-849-2204
Mailing Address - Fax:215-844-8359
Practice Address - Street 1:536 WALNUT LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1741
Practice Address - Country:US
Practice Address - Phone:215-849-2204
Practice Address - Fax:215-482-5695
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023951E208600000X
CAG86283208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0730213Medicaid
PAC33495Medicare UPIN
PA0730213Medicaid