| |
3641 Lancaster Ave, Philadelphia, PA 19104-2603 | |
(215) 387-1025 | |
(215) 387-0765 |
Full Name | |
---|---|
Type | Facility |
Speciality | Internal Medicine |
Location | 3641 Lancaster Ave, Philadelphia, Pennsylvania |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1891823449 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | DC0051922 (Pennsylvania) | Primary |
207R00000X | Internal Medicine | OS002335L (Pennsylvania) | Primary |
Mailing Address | Practice Location Address |
---|---|
3641 Lancaster Ave, Philadelphia, PA 19104-2603 Ph: (215) 387-1025 | 3641 Lancaster Ave, Philadelphia, PA 19104-2603 Ph: (215) 387-1025 |