Healthcare Provider Details

I. General information

NPI: 1306893441
Provider Name (Legal Business Name): PENNSYLVANIA MEDICAL PROFESSIONALS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8835 GERMANTOWN AVE
PHILADELPHIA PA
19118-2718
US

IV. Provider business mailing address

8835 GERMANTOWN AVE
PHILADELPHIA PA
19118-2718
US

V. Phone/Fax

Practice location:
  • Phone: 215-248-8333
  • Fax: 215-248-8989
Mailing address:
  • Phone: 215-248-8333
  • Fax: 215-248-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY NEWSOME
Title or Position: SENIOR VP
Credential:
Phone: 888-547-9776