Provider Demographics
NPI:1013987544
Name:COX, JONATHAN M (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:COX
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:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-671-3939
Practice Address - Street 1:10101 BUSTLETON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3703
Practice Address - Country:US
Practice Address - Phone:215-671-3920
Practice Address - Fax:215-671-3939
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026229E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA35053MD026229EOtherHEALTH PARTNERS
PA0019156600009Medicaid
PA2190739000OtherKEYSTONE IBC
PA4552547OtherAETNA PPO
PA6837843OtherAETNA HMO
PA1502183OtherHIGHMARK BLUE SHIELD
PA30061448OtherKEYSTONE MERCY
PA0019156600009Medicaid
PA063112GH2Medicare PIN
PA1502183OtherHIGHMARK BLUE SHIELD