Healthcare Provider Details

I. General information

NPI: 1285897496
Provider Name (Legal Business Name): ANTONIO ANGELOU PARHAM R.N
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HICKORY RD STE 240
PLYMOUTH MEETING PA
19462-2225
US

IV. Provider business mailing address

6120 W OXFORD ST 2ND FLOOR
PHILADELPHIA PA
19151-4540
US

V. Phone/Fax

Practice location:
  • Phone: 610-834-1122
  • Fax: 610-834-7525
Mailing address:
  • Phone: 215-439-3518
  • Fax: 215-877-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN576639
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: