Healthcare Provider Details

I. General information

NPI: 1194765339
Provider Name (Legal Business Name): PENNSYLVANIA MEDICAL PROFESSIONALS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 GERMANTOWN AVE
PHILADELPHIA PA
19118-2718
US

IV. Provider business mailing address

8811 GERMANTOWN AVE
PHILADELPHIA PA
19118-2718
US

V. Phone/Fax

Practice location:
  • Phone: 215-248-6107
  • Fax: 215-248-6106
Mailing address:
  • Phone: 215-248-6107
  • Fax: 215-248-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY NEWSOME
Title or Position: SENIOR VP
Credential:
Phone: 215-248-6107