Healthcare Provider Details

I. General information

NPI: 1699817056
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF BRIDESBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 E THOMPSON ST
PHILADELPHIA PA
19137-2003
US

IV. Provider business mailing address

4517 E THOMPSON ST
PHILADELPHIA PA
19137-2003
US

V. Phone/Fax

Practice location:
  • Phone: 215-535-1275
  • Fax: 215-535-8690
Mailing address:
  • Phone: 215-535-1275
  • Fax: 215-535-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS005625L
License Number StatePA

VIII. Authorized Official

Name: BRIAN BERNOT KIMMEL
Title or Position: PRESIDENT
Credential: DO
Phone: 215-535-1275