Healthcare Provider Details

I. General information

NPI: 1962467241
Provider Name (Legal Business Name): ARIA HEALTH PHYSICIAN SERVICES-GYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 RED LION RD SUITE 106
PHILADELPHIA PA
19114-1436
US

IV. Provider business mailing address

PO BOX 825395
PHILADELPHIA PA
19182-5395
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4143
  • Fax: 215-612-4909
Mailing address:
  • Phone: 215-481-6836
  • Fax: 215-481-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StatePA

VIII. Authorized Official

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