MEDICARE: BETHANY PEDIATRICS, LLC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1366627085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	7408 W CHESTER PIKE
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2006
Country	:	US
Telephone Number	:	610-734-1600
Fax Number	:	610-734-0434

Provider Business Practice Location Address
First Line	:	7408 W CHESTER PIKE
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2006
Country	:	US
Telephone Number	:	610-734-1600
Fax Number	:	610-734-0434

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GODSON K ASAMOA
Credential	:	MD
Telephone Number	:	610-931-1502

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	06/10/2011

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