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NPI Code Detail

MEDICARE: SPECIALTY MANAGEMENT

MEDICARE: SPECIALTY MANAGEMENT
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
1122300000XDentist
21223X0400XOrthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number : 1720259583
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECIALTY MANAGEMENT
Provider Business Mailing Address
First Line : 626 SNYDER AVE
Second Line : SUITE 200
City : PHILADELPHIA
State : PA
Zip : 19148-2419
Country : US
Telephone Number : 267-940-0300
Fax Number :
Provider Business Practice Location Address
First Line : 626 SNYDER AVE
Second Line : SUITE 200
City : PHILADELPHIA
State : PA
Zip : 19148-2419
Country : US
Telephone Number : 267-940-0300
Fax Number :
Authorized Official
Title or Position : PRESIDENT/CEO
Name : MS. SOPHIA AVANZATO
Credential :
Telephone Number : 484-432-2737
Provider Enumeration Date : 03/19/2008
Last Update Date : 03/19/2008

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Directions to “SPECIALTY MANAGEMENT ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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