Provider Demographics
NPI:1255422135
Name:ACZON, FERDINAND ANDRES (MD)
Entity type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:ANDRES
Last Name:ACZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4748
Mailing Address - Country:US
Mailing Address - Phone:215-739-8777
Mailing Address - Fax:215-739-9016
Practice Address - Street 1:2724 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-2701
Practice Address - Country:US
Practice Address - Phone:215-739-8777
Practice Address - Fax:215-739-9016
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD08982L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009300270004Medicaid
PAB40869Medicare UPIN
PAAC184790Medicare ID - Type Unspecified