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2300 W Master St Philadelphia PA 19121-4739 | |
| (215) 236-8289 | |
| (215) 236-3521 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 2300 W Master St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Marcella E. Lingham (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2152270300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2501 W Lehigh Ave Philadelphia PA 19132-3207 Ph: (215) 227-0300 | 2300 W Master St Philadelphia PA 19121-4739 Ph: (215) 236-8289 |
| NPI Number | 1548373574 |
|---|---|
| Provider Enumeration Date | 08/16/2006 |
| Last Update Date | 05/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548373574 | NPI | - | NPPES |
| 1007588070004 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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