MEDICARE: ARIA HEALTH PHYSICIAN SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1023621471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIA HEALTH PHYSICIAN SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 825395
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-5395
Country	:	US
Telephone Number	:	215-481-4790
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 ROOSEVELT BLVD STE 206B
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1027
Country	:	US
Telephone Number	:	215-671-8900
Fax Number	:	215-671-1272

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	RONALD KUMOR
Credential	:
Telephone Number	:	215-612-4858

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	10/12/2022

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