Provider Demographics
NPI:1144363250
Name:PERICLES, JOHN THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:PERICLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:112 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-8521
Mailing Address - Country:US
Mailing Address - Phone:609-927-0554
Mailing Address - Fax:
Practice Address - Street 1:801 BOARDWALK
Practice Address - Street 2:WHOLE HEALTH WELLNESS CENTER
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7509
Practice Address - Country:US
Practice Address - Phone:609-343-4003
Practice Address - Fax:609-343-4006
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB58296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG02293Medicare UPIN