MEDICARE: PENN STATE HEALTH MEDICAL GROUP, 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	:	1609347152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENN STATE HEALTH MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 825972
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-5972
Country	:	US
Telephone Number	:	717-531-4859
Fax Number	:	717-312-3104

Provider Business Practice Location Address
First Line	:	655 WALNUT ST
Second Line	:
City	:	WEST READING
State	:	PA
Zip	:	19611-1242
Country	:	US
Telephone Number	:	610-372-9222
Fax Number	:	610-372-0232

Authorized Official
Title or Position	:	VP, CHIEF FINANCIAL OFFICER
Name	:	TRACY L MOYER-SWINKO
Credential	:
Telephone Number	:	717-531-8477

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	02/03/2026

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