Healthcare Provider Details

I. General information

NPI: 1407808033
Provider Name (Legal Business Name): ALBERT JAMES MAMARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: A. JAMES MAMARY MD

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-5864
  • Fax: 215-707-6867
Mailing address:
  • Phone: 215-707-5864
  • Fax: 215-707-6867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD-418340
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberMD-418340
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD-418340
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: