MEDICARE: TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP

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	207Q00000X	Family Medicine Physician		PA

General Provider Information

NPI Number	:	1861917544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP

Provider Business Mailing Address
First Line	:	41 UNIVERSITY DR STE 300
Second Line	:
City	:	NEWTOWN
State	:	PA
Zip	:	18940-1873
Country	:	US
Telephone Number	:	734-343-2654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1407 RHAWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2803
Country	:	US
Telephone Number	:	215-624-6007
Fax Number	:	215-624-6465

Authorized Official
Title or Position	:	VP, FINANCE AND CFO
Name	:	JULIE KEESE
Credential	:
Telephone Number	:	301-754-7201

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	03/13/2026

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