Healthcare Provider Details

I. General information

NPI: 1851774897
Provider Name (Legal Business Name): GEPS PHYSICIAN GROUP OF PENNSYLVANIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E LA CANADA BLVD
AVONDALE AZ
85323-1643
US

IV. Provider business mailing address

PO BOX 42738
TOWSON MD
21284-2738
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-2282
  • Fax:
Mailing address:
  • Phone: 410-494-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC SHAPIRO
Title or Position: VP/AREA CONTROLLER
Credential:
Phone: 410-832-7790