Healthcare Provider Details

I. General information

NPI: 1457049439
Provider Name (Legal Business Name): FAIR HILL COMMUNITY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W HUNTING PARK AVE
PHILADELPHIA PA
19140-2717
US

IV. Provider business mailing address

3500 N BROAD ST
PHILADELPHIA PA
19140-4106
US

V. Phone/Fax

Practice location:
  • Phone: 215-324-0600
  • Fax: 215-324-2795
Mailing address:
  • Phone: 215-324-0600
  • Fax: 215-324-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET FERRARIE
Title or Position: SR. MANAGER PAYER CREDENTIALING
Credential:
Phone: 215-707-2433