Healthcare Provider Details

I. General information

NPI: 1770547499
Provider Name (Legal Business Name): PHILADELPHIA HEALTH ASSOCIATES-PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BALA AVE STE 102
BALA CYNWYD PA
19004-3214
US

IV. Provider business mailing address

25 BALA AVE STE 102
BALA CYNWYD PA
19004-3214
US

V. Phone/Fax

Practice location:
  • Phone: 215-452-0304
  • Fax: 215-452-0311
Mailing address:
  • Phone: 215-452-0304
  • Fax: 215-452-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD006904E
License Number StatePA

VIII. Authorized Official

Name: MS. DARLENE JAMES
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-452-0304