Healthcare Provider Details

I. General information

NPI: 1003853532
Provider Name (Legal Business Name): PRIMARY CARE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 E ALLEGHENY AVE
PHILADELPHIA PA
19134-3830
US

IV. Provider business mailing address

2236 E ALLEGHENY AVE
PHILADELPHIA PA
19134-3830
US

V. Phone/Fax

Practice location:
  • Phone: 215-634-8000
  • Fax: 215-634-1760
Mailing address:
  • Phone: 215-634-8000
  • Fax: 215-634-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN BRIGLIO
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-634-8000