Provider Demographics
NPI:1023751880
Name:NEGRO, JOHN MARK JR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:NEGRO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-1918
Mailing Address - Country:US
Mailing Address - Phone:215-588-9864
Mailing Address - Fax:
Practice Address - Street 1:301 S 8TH ST STE 2I
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4017
Practice Address - Country:US
Practice Address - Phone:276-322-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA141213367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered