| Residentialist Housecall Med Grp, Pc A Pennsylvania Corp | |
|
4190 City Ave Pcom - Rowland Hall, Room 528 Philadelphia PA 19131-1626 | |
| (949) 366-1053 | |
| (949) 544-7880 |
| Full Name | Residentialist Housecall Med Grp, Pc A Pennsylvania Corp |
|---|---|
| Speciality | Family Medicine |
| Location | 4190 City Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Norman Edward Vinn (CEO, CFO, AND SECRETARY) |
| Authorized Official Contact | 9493661053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Residentialist Housecall Med Grp, Pc A Pennsylvania Corp 3800 Kilroy Airport Way Ste 270 Long Beach CA 90806-2497 Ph: (949) 366-1053 | Residentialist Housecall Med Grp, Pc A Pennsylvania Corp 4190 City Ave Pcom - Rowland Hall, Room 528 Philadelphia PA 19131-1626 Ph: (949) 366-1053 |
| NPI Number | 1104205400 |
|---|---|
| Provider Enumeration Date | 05/20/2015 |
| Last Update Date | 08/01/2024 |
| Medicare PECOS PAC ID | 7416263199 |
|---|---|
| Medicare Enrollment ID | O20150825005345 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104205400 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | OS017618 (Pennsylvania) | Primary |
| Provider Name | Katherine Galluzzi |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1336140979 PECOS PAC ID: 9537063896 Enrollment ID: I20031120000095 |
| Provider Name | Michael Ernest Srulevich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275670655 PECOS PAC ID: 4486698602 Enrollment ID: I20050617000356 |
| Provider Name | Jeffrey J Maron |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295775963 PECOS PAC ID: 0446266308 Enrollment ID: I20060301000575 |
| Provider Name | Nicol Eudora Joseph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568494029 PECOS PAC ID: 1052316874 Enrollment ID: I20060928000349 |
| Provider Name | Roxanne M Sides |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174708218 PECOS PAC ID: 7911086186 Enrollment ID: I20080430000262 |
| Provider Name | Dawn M Culbreath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316298219 PECOS PAC ID: 4486806684 Enrollment ID: I20121217000254 |
| Provider Name | Marie C Metz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851703508 PECOS PAC ID: 5597088401 Enrollment ID: I20141230000700 |
| Provider Name | Norman Edward Vinn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568417525 PECOS PAC ID: 5991781643 Enrollment ID: I20150825005488 |
| Provider Name | Ryan B Sholinsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922544923 PECOS PAC ID: 3173807138 Enrollment ID: I20170313000309 |
| Provider Name | Tynisha Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760908123 PECOS PAC ID: 3577839257 Enrollment ID: I20171024003383 |
| Provider Name | Dana P Ridley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699273615 PECOS PAC ID: 3476899014 Enrollment ID: I20190117003717 |
| Provider Name | Maudeline Paul |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720749674 PECOS PAC ID: 6103210919 Enrollment ID: I20220221001593 |
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