| Patina Medical Group, Pc | |
|
150 Monument Rd Bala Cynwyd PA 19004-1702 | |
| (949) 246-3344 | |
| Not Available |
| Full Name | Patina Medical Group, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 150 Monument Rd, Bala Cynwyd, Pennsylvania |
| Authorized Official Name and Position | Alexandra Marie Ristow (LEAD PRIMARY CARE PHYSICIAN) |
| Authorized Official Contact | 5739997137 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Patina Medical Group, Pc 150 Monument Rd Bala Cynwyd PA 19004-1702 Ph: (855) 478-8208 | Patina Medical Group, Pc 150 Monument Rd Bala Cynwyd PA 19004-1702 Ph: (949) 246-3344 |
| NPI Number | 1801568910 |
|---|---|
| Provider Enumeration Date | 09/28/2021 |
| Last Update Date | 08/02/2022 |
| Certification Date | 08/02/2022 |
| Medicare PECOS PAC ID | 2567828460 |
|---|---|
| Medicare Enrollment ID | O20230518003521 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801568910 | NPI | - | NPPES |
| Provider Name | Kathleen A Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568554145 PECOS PAC ID: 6305030156 Enrollment ID: I20101105000134 |
| Provider Name | Jamie Sikora |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801294954 PECOS PAC ID: 6901117308 Enrollment ID: I20200309000177 |
| Provider Name | Michelle Lu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750856803 PECOS PAC ID: 9133559669 Enrollment ID: I20210609003280 |
| Provider Name | Alexandra Ristow |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114361839 PECOS PAC ID: 7113210105 Enrollment ID: I20230524000512 |
| Provider Name | Kathryn Maceyko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760856736 PECOS PAC ID: 1658728993 Enrollment ID: I20231108002908 |
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