Provider Demographics
NPI:1669558748
Name:PYM, JOHN (MB, BS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:PYM
Suffix:
Gender:M
Credentials:MB, BS
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:215-612-5214
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:SUITE 214
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1445
Practice Address - Country:US
Practice Address - Phone:215-612-5050
Practice Address - Fax:215-612-5214
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067548L208G00000X
DEC10006870208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017415160009Medicaid
PA6373393OtherAETNA HMO
PA996709OtherHIGHMARK BLUE SHIELD
PA001741516Medicaid
PA30074497OtherKEYSTONE MERCY
PA34705MD067548LOtherHEALTH PARTNERS
PA440771OtherMLHC MEDICARE AA#
PA440771OtherMLHC MEDICARE AA#
PA001741516Medicaid