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2501 W Lehigh Ave Philadelphia PA 19132-3207 | |
| (215) 227-0300 | |
| (215) 227-0302 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2501 W Lehigh Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Marcella L Lingham (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2152270300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2501 W Lehigh Ave Philadelphia PA 19132-3207 Ph: (215) 227-0300 | 2501 W Lehigh Ave Philadelphia PA 19132-3207 Ph: (215) 227-0300 |
| NPI Number | 1861490583 |
|---|---|
| Provider Enumeration Date | 07/07/2005 |
| Last Update Date | 05/31/2019 |
| Medicare PECOS PAC ID | 6901821008 |
|---|---|
| Medicare Enrollment ID | O20051007000534 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861490583 | NPI | - | NPPES |
| 1007588070001 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Esther Cindy Lendor |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1063469831 PECOS PAC ID: 1759295520 Enrollment ID: I20050124000875 |
| Provider Name | Sean D Green |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548296601 PECOS PAC ID: 9931155736 Enrollment ID: I20050328000024 |
| Provider Name | Marshall K Gardner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750354783 PECOS PAC ID: 6002080173 Enrollment ID: I20111219000041 |
| Provider Name | Matthew Roman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558649061 PECOS PAC ID: 1456578111 Enrollment ID: I20140805000109 |
| Provider Name | Fahmida Hussain |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1114112380 PECOS PAC ID: 3779849682 Enrollment ID: I20171109001052 |
| Provider Name | Shaina Ann Thomas |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1467820357 PECOS PAC ID: 9234478777 Enrollment ID: I20190228001168 |
| Provider Name | Wanda Faye Cacho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184296121 PECOS PAC ID: 5991024002 Enrollment ID: I20220321000291 |
| Provider Name | Guanjun Cheng |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841950383 PECOS PAC ID: 8325433857 Enrollment ID: I20220321001542 |
| Provider Name | Sakinah Abdulkhabir |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740057439 PECOS PAC ID: 2062854052 Enrollment ID: I20240522001462 |
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