DR. JEREMY WYNNE CANNON (NPI# 1952368136) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952368136 |
| Entity Type | Individual |
| Full Name | DR. JEREMY WYNNE CANNON |
| Credential | M.D. |
| Practice Address |
51 N 39th Street Suite 120 Mob Philadelphia PA 19104 |
| Practice Telephone | 2156627323 |
| Practice Fax Number | 2152434679 |
| Mailing Telephone | 2156627323 |
| Mailing Fax Number | 2152434679 |
| Enumeration Date | 2006-04-29 |
| Last Update Date | 2019-11-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2086S0102X |
Surgery Specialization: Surgical Critical Care |
MD454530 | PA | Allopathic & Osteopathic Physicians |
| Y | 2086S0127X |
Surgery Specialization: Trauma Surgery |
MD454530 | PA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467824953 | Jeremy Doyle Cannon | Chiropractor | 704 E Arlington Blvd, Greenville, NC 27858-5809 | 2015-10-23 |
| 1093175010 | Jeremy Cannon | Physical Therapy Assistant | 1787 Allendale Fairfax Hwy, Fairfax, SC 29827-9133 | 2016-03-03 |
| 1457628091 | Jeremy Cannon | Case Manager/Care Coordinator | 179 S Parkside Dr, Colorado Springs, CO 80910-3130 | 2011-11-28 |
| 1578842258 | Jeremy Jon Cannon | Counselor | 5110 S Florida Ave Ste 105, Lakeland, FL 33813-2517 | 2011-08-11 |
| Street Address |
51 N 39TH STREET SUITE 120 MOB |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770053324 | Maura Levandowski | Nurse Practitioner | 51 N 39th Street, Philadelphia, PA 19104 | 2018-11-27 |
| 1730334277 | Gerald M O'neill | Emergency Medicine | 51 N 39th Street, Presbyterian Medical Center, Philadelphia, PA 19104-2640 | 2008-11-25 |
| 1114139573 | Suzana Luiza Tsao | Emergency Medicine | 51 N 39th Street, Philadelphia, PA 19104-2640 | 2007-05-05 |
| 1639203128 | Jeremy J Flood | Internal Medicine | 51 N 39th Street, Suite 2a, Philadelphia, PA 19104-2640 | 2007-03-15 |
| 1710069893 | Maria O Uberti-benz | Dermatology | 51 N 39th Street, Medical Arts Building Suite 106, Philadelphia, PA 19104-2640 | 2006-10-19 |
| 1154432839 | Richard A Stone | Ophthalmology | 51 N 39th Street, Scheie Eye Institute, Philadelphia, PA 19104 | 2006-08-31 |
| 1124139746 | Joshua L Dunaief | Ophthalmology | 51 N 39th Street, Scheie Eye Institute, Philadelphia, PA 19104 | 2006-08-31 |
| 1699706994 | John R Bullinga | Internal Medicine | 51 N 39th Street, 4 Phi, Philadelphia, PA 19104-2640 | 2006-07-05 |
| 1972531432 | David L Glaser | Orthopaedic Surgery | 51 N 39th Street, 1 Cupp Pavilion, Philadelphia, PA 19104-2640 | 2006-06-30 |
| 1609803840 | David M Finkel | Internal Medicine | 51 N 39th Street, Mob Suite 280, Philadelphia, PA 19104 | 2006-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639770829 | Michelle Morris | Student in an Organized Health Care Education/Training Program | Dept. of Family Medicine & Community Health, 3737 Market, Philadelphia, PA 19104 | 2020-11-04 |
| 1346853041 | Spectrum Health Services, Inc. | Clinic/Center | 1415 South University Ave, Philadelphia, PA 19104 | 2020-08-24 |
| 1770104259 | Fatimah Sorefan-mangou | Student in an Organized Health Care Education/Training Program | 4 Maloney 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1114548690 | Rebecca Blaguski | Registered Nurse | The Hospital of The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 | 2020-05-06 |
| 1952944175 | Rebecca Miriam Barmherzig | Psychiatry & Neurology | 3501 Civic Centre Blvd, 10th Flr Ctrb, Neurology, Philadelphia, PA 19104 | 2019-10-21 |
| 1891257101 | James Paul Byrne | Surgery | Penn Presbyterian Medical Center, Division of Trauma, S, 51 N. 39th Street, Suite 120, 1st Floor Medical Office, Philadelphia, PA 19104 | 2019-04-04 |
| 1093276453 | Lauren Shreve | Student in an Organized Health Care Education/Training Program | Department of Surgery, Surgery Education - Penn Health, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104 | 2019-03-28 |
| 1285194282 | Lauren M Christie | Student in an Organized Health Care Education/Training Program | Penn Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA 19104 | 2019-03-25 |
| 1114487683 | Sabrina Layne | Student in an Organized Health Care Education/Training Program | 3400 Spruce Street, 100 Centrex, Philadelphia, PA 19104 | 2019-03-21 |
| 1811457310 | Kia Lor | Student in an Organized Health Care Education/Training Program | Hospital of University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 | 2019-03-21 |
| Find all providers in zip 19104 | ||||
| Taxonomy Code | 2086S0127X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Trauma Surgery |
| Trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency. |
| Notes: Source: American Board of Surgery, 2007 [1/1/2008: definition added, source added] Additional Resources: http://www.absurgery.org/. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629377262 | Filip Moshkovsky | Surgery | 51 N 39th St Ste 1, Philadelphia, PA 19104-2640 | 2011-03-22 |
| 1770895971 | Morgan Mcmonagle | Surgery | 3400 Spruce St, Philadelphia, PA 19104-4206 | 2010-07-06 |
| 1558497644 | Aria Health Physician Services - Trauma | Surgery | 3998 Red Lion Rd, Trauma Department, Philadelphia, PA 19114-1436 | 2007-02-26 |
| 1154478774 | Bartholomew Joseph Tortella | Surgery | Broad and Vine Streets, Philadelphia, PA 19102-1121 | 2007-01-04 |
| 1093805855 | Richard K Burns | Surgery | 230 N Broad Street, Philadelphia, PA 19102 | 2006-10-13 |
| 1881799260 | Philadelphia Health & Education Corp | Surgery | 219 N Broad St, 8th Floor, Philadelphia, PA 19107-1519 | 2006-09-13 |
| 1184642712 | Gary Welch | Surgery | 3998 Red Lion Rd, Philadelphia, PA 19114-1436 | 2006-07-18 |
| 1215967682 | Mark J. Libassi | Surgery | 3998 Red Lion Rd, Suite 125, Philadelphia, PA 19114-1436 | 2006-07-03 |
| 1740219955 | Alfred R. Bogucki | Surgery | 3998 Red Lion Rd, Suite 211, Philadelphia, PA 19114-1445 | 2006-07-01 |
| 1104880970 | Alec C Beekley | Surgery | 1100 Walnut St, 5th Floor, Philadelphia, PA 19107-5563 | 2006-04-17 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.