| Indepedence Medical Associates P.c. | |
|
3790 Morrell Ave Philadelphia PA 19114-1955 | |
| (215) 612-1450 | |
| (215) 612-1420 |
| Full Name | Indepedence Medical Associates P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 3790 Morrell Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Jay Glickman (PHYSICIAN) |
| Authorized Official Contact | 2156121450 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indepedence Medical Associates P.c. 3790 Morrell Ave Philadelphia PA 19114-1955 Ph: (215) 612-1450 | Indepedence Medical Associates P.c. 3790 Morrell Ave Philadelphia PA 19114-1955 Ph: (215) 612-1450 |
| NPI Number | 1053348953 |
|---|---|
| Provider Enumeration Date | 06/27/2006 |
| Last Update Date | 10/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053348953 | NPI | - | NPPES |
| 2222546001 | Other | PA | KEYSTONE HMO ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS 009194-L (Pennsylvania) | Primary |
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