| Advanced Family Medicine P.c. | |
|
14200 Bustleton Ave Suite 4 Philadelphia PA 19116-1186 | |
| (215) 671-0900 | |
| (215) 671-8114 |
| Full Name | Advanced Family Medicine P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 14200 Bustleton Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Alexander Tarnopolsky (PHYSICIAN) |
| Authorized Official Contact | 2672427993 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Family Medicine P.c. 14200 Bustleton Ave Suite 4 Philadelphia PA 19116-1186 Ph: (215) 671-0900 | Advanced Family Medicine P.c. 14200 Bustleton Ave Suite 4 Philadelphia PA 19116-1186 Ph: (215) 671-0900 |
| NPI Number | 1790979870 |
|---|---|
| Provider Enumeration Date | 08/31/2007 |
| Last Update Date | 08/31/2007 |
| Medicare PECOS PAC ID | 2567558141 |
|---|---|
| Medicare Enrollment ID | O20071011000652 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790979870 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | OS010564L (Pennsylvania) | Primary |
| Provider Name | Alexander Tarnopolsky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154541027 PECOS PAC ID: 6305806894 Enrollment ID: I20041019000506 |
| Provider Name | Boben Babu |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1679025548 PECOS PAC ID: 2567743560 Enrollment ID: I20170106000134 |
| Provider Name | Dmitry Ulend |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306344718 PECOS PAC ID: 1557621729 Enrollment ID: I20220816002768 |
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