Healthcare Provider Details

I. General information

NPI: 1124665567
Provider Name (Legal Business Name): HANNAH MARIE COMINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

216 W. SOMERSET ST ESTUERZO PROGRAM
PHILADELPHIA PA
19133
US

IV. Provider business mailing address

216 W. SOMERSET ST ESTUERZO PROGRAM
PHILADELPHIA PA
19133
US

V. Phone/Fax

Practice location:
  • Phone: 215-763-8872
  • Fax: 215-223-2936
Mailing address:
  • Phone: 215-763-8872
  • Fax: 215-223-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: