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NPI Code Detail

MEDICARE: EPIC PHYSICIANS MEDICAL PRACTICE

MEDICARE: EPIC PHYSICIANS MEDICAL PRACTICE
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
1207Q00000XFamily Medicine PhysicianOS004384-LPA

General Provider Information

NPI Number : 1942630678
Entity Type Code : Organization
Provider Name (Legal Business Name) : EPIC PHYSICIANS MEDICAL PRACTICE
Provider Business Mailing Address
First Line : 8019 FRANKFORD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19136-2786
Country : US
Telephone Number : 215-332-1300
Fax Number : 215-332-5219
Provider Business Practice Location Address
First Line : 8019 FRANKFORD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19136-2786
Country : US
Telephone Number : 215-332-1300
Fax Number : 215-332-5219
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. JOSEPH V PONGONIS
Credential : DO
Telephone Number : 215-332-1300
Provider Enumeration Date : 11/15/2013
Last Update Date : 05/16/2014

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Directions to “EPIC PHYSICIANS MEDICAL PRACTICE ” Practice Location

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