| Fademos Family Practice | |
|
16 Old Ashton Rd Ste 1 Philadelphia PA 19152-1661 | |
| (215) 613-5069 | |
| (215) 613-6809 |
| Full Name | Fademos Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 16 Old Ashton Rd Ste 1, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Mariam Salahou (CEO/CLINICAL DIRECTOR) |
| Authorized Official Contact | 2156135069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fademos Family Practice 16 Old Ashton Rd Ste 1 Philadelphia PA 19152-1661 Ph: (215) 613-5069 | Fademos Family Practice 16 Old Ashton Rd Ste 1 Philadelphia PA 19152-1661 Ph: (215) 613-5069 |
| NPI Number | 1801138896 |
|---|---|
| Provider Enumeration Date | 03/18/2013 |
| Last Update Date | 03/18/2013 |
| Medicare PECOS PAC ID | 6709017999 |
|---|---|
| Medicare Enrollment ID | O20140402000354 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801138896 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | SP008704 (Pennsylvania) | Primary |
| Provider Name | Mariam Salahou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780698613 PECOS PAC ID: 1557383494 Enrollment ID: I20051220000774 |
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