Healthcare Provider Details

I. General information

NPI: 1316072077
Provider Name (Legal Business Name): ARIA HEALTH PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 ROOSEVELT BLVD SUITE 206-B
PHILADELPHIA PA
19114-1025
US

IV. Provider business mailing address

PO BOX 825395
PHILADELPHIA PA
19182-5395
US

V. Phone/Fax

Practice location:
  • Phone: 215-671-8900
  • Fax: 215-671-1272
Mailing address:
  • Phone: 215-671-8900
  • Fax: 215-671-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: RONALD M. KUMOR
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 215-612-4858