MEDICARE: MT. AIRY PEDIATRICS, P.C.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000465921	OTHER	PA	BLUE SHIELD/HIGH MARK
2	1781620	OTHER	PA	UNITED HEALTHCARE
3	6524	OTHER	PA	AETNA
4	1026452	OTHER	PA	KEYSTONE MERCY
5	0055732001	OTHER	PA	INDEPENDENCE BLUE CROSS

General Provider Information

NPI Number	:	1730516659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT. AIRY PEDIATRICS, P.C.

Provider Business Mailing Address
First Line	:	6673 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2252
Country	:	US
Telephone Number	:	215-247-2996
Fax Number	:	215-247-7504

Provider Business Practice Location Address
First Line	:	6673 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2252
Country	:	US
Telephone Number	:	215-247-2996
Fax Number	:	215-247-7504

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	JENNIFER LOUIS JADOTTE
Credential	:
Telephone Number	:	215-247-2996

Provider Enumeration Date	:	10/09/2013
Last Update Date	:	04/26/2022

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