| Doctor Name: | DR. JAVIER ANDRES TELLAGORRY |
| NPI Number: | 1053544627 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | |
| Business Practice Address: | 1200 Old York Rd Abington, PA - 190013720 |
| Business Phone Number: | 2154817320 |
| Business Fax Number: | |
| Mailing Address: | 3213 Brookview Pl, ELKINS PARK |
| State: | PA |
| Postal Code: | 190272807 |
| Phone Number: | 3303894747 |
| Fax Number: | |
| NPI Enumeration Date: | 08/31/2009 |
| NPI Last Update Date: | 08/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |