MEDICARE: NAZARETH PHYSICIAN SERVICES INC

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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1265682082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAZARETH PHYSICIAN SERVICES INC

Provider Business Mailing Address
First Line	:	1 W ELM ST
Second Line	:	SUITE 100
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-4108
Country	:	US
Telephone Number	:	610-567-5513
Fax Number	:	610-567-6955

Provider Business Practice Location Address
First Line	:	3461 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1605
Country	:	US
Telephone Number	:	215-624-6007
Fax Number	:	215-624-6465

Authorized Official
Title or Position	:	VP FINANCE
Name	:	DAVID WAJDA
Credential	:
Telephone Number	:	215-335-6043

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	04/08/2010

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Directions to “NAZARETH PHYSICIAN SERVICES INC ” Practice Location

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