Provider Demographics
NPI:1033616842
Name:JO, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:JO
Suffix:
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 1:152 MAHOGANY LN
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2169
Mailing Address - Country:US
Mailing Address - Phone:240-449-9964
Mailing Address - Fax:
Practice Address - Street 1:255 W LANCASTER AVE STE 332
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1766
Practice Address - Country:US
Practice Address - Phone:610-647-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS020824208600000X
PA1033616842208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery