| Medical Center Of Bustleton Pc | |
|
9622 Bustleton Avenue Suite 6 Philadelphia PA 19115-3100 | |
| (215) 673-7067 | |
| (215) 673-4966 |
| Full Name | Medical Center Of Bustleton Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 9622 Bustleton Avenue, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Donna Marie Gavarone (PRESIDENT OWNER) |
| Authorized Official Contact | 2156737067 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Center Of Bustleton Pc 9622 Bustleton Avenue Suite 6 Philadelphia PA 19115-3100 Ph: (215) 673-7067 | Medical Center Of Bustleton Pc 9622 Bustleton Avenue Suite 6 Philadelphia PA 19115-3100 Ph: (215) 673-7067 |
| NPI Number | 1861576753 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 06/29/2010 |
| Medicare PECOS PAC ID | 8123002912 |
|---|---|
| Medicare Enrollment ID | O20040617001231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861576753 | NPI | - | NPPES |
| 0015772220005 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Donna M Gavarone |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881640738 PECOS PAC ID: 4880780279 Enrollment ID: I20101015000748 |
| Provider Name | Shari B Klugman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861448714 PECOS PAC ID: 5890988372 Enrollment ID: I20101015000785 |
| Provider Name | Gene I Geld |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104867159 PECOS PAC ID: 4880830561 Enrollment ID: I20130425000254 |
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