Healthcare Provider Details

I. General information

NPI: 1124069869
Provider Name (Legal Business Name): PENNSYLVANIA PULMONARY MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SPRUCE STREET SUITE 500
PHILADELPHIA PA
19106-4027
US

IV. Provider business mailing address

700 SPRUCE STREET SUTE 500
PHILADELPHIA PA
19106-4027
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-5027
  • Fax: 215-829-6391
Mailing address:
  • Phone: 215-829-5027
  • Fax: 215-829-6391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL P CASEY
Title or Position: PRESIDENT
Credential: MD
Phone: 215-829-5027