| Fountain Medical Associates P C | |
|
22 E Mount Airy Ave Philadelphia PA 19119 | |
| (215) 924-2440 | |
| (267) 437-2346 |
| Full Name | Fountain Medical Associates P C |
|---|---|
| Speciality | Family Medicine |
| Location | 22 E Mount Airy Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Safiyya S Shabazz (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2159242440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fountain Medical Associates P C 22 E Mount Airy Ave Philadelphia PA 19119-1712 Ph: (215) 924-2440 | Fountain Medical Associates P C 22 E Mount Airy Ave Philadelphia PA 19119 Ph: (215) 924-2440 |
| NPI Number | 1215257837 |
|---|---|
| Provider Enumeration Date | 06/04/2010 |
| Last Update Date | 07/27/2018 |
| Medicare PECOS PAC ID | 1456531813 |
|---|---|
| Medicare Enrollment ID | O20110202000673 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215257837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD428070 (Pennsylvania) | Primary |
| Provider Name | Safiyya S Shabazz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033147178 PECOS PAC ID: 9335157742 Enrollment ID: I20060329000619 |
| Provider Name | Valeria Marie Muhammad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609389477 PECOS PAC ID: 8921347576 Enrollment ID: I20190227000408 |
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