Basic Information
| Provider Information | |||||||||
| NPI: | 1326247388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEATON | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 SANSOM ST | ||||||||
| Address2: | 1651 THOMPSON, EMERGENCY MEDICINE DEPARTMENT | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159559837 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 SANSOM ST | ||||||||
| Address2: | 1651 THOMPSON, EMERGENCY MEDICINE DEPARTMENT | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159559837 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 07/31/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MT191498 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.