Mydlo, Jack H

Mydlo, Jack H is an individual health care provider with primary practice located at 3401 N Broad St 3Rd Floor Parkinson Pavilion, Philadelphia PA 19140-5103. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Mydlo, Jack H can be contacted via phone (215) 707-3375.

Contact Information

Primary practice address
3401 N Broad St 3Rd Floor Parkinson Pavilion Philadelphia PA 19140-5103
Phone: (215) 707-3375
Fax: (215) 707-4758
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X MD071004L Pennsylvania

Profile Details

NPI number 1780672881
LBN Legal business name Mydlo, Jack H
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2005
Last updated Mar 21st, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780672881 NPPES
Pennsylvania MEDICAID 0078049200001

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