Healthcare Provider Details

I. General information

NPI: 1053181297
Provider Name (Legal Business Name): ARIA HEALTH PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 ROOSEVELT BLVD STE 100
PHILADELPHIA PA
19114-1026
US

IV. Provider business mailing address

PO BOX 825395
PHILADELPHIA PA
19182-5395
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-6162
  • Fax:
Mailing address:
  • Phone: 215-481-6836
  • Fax: 215-481-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RACHEL RENAE DANTIS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 609-238-7660