Healthcare Provider Details

I. General information

NPI: 1235116344
Provider Name (Legal Business Name): RHEUMATIC DISEASE ASSOCIATES,LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 MARYLAND ROAD
WILLOW GROVE PA
19090
US

IV. Provider business mailing address

2360 MARYLAND RD
WILLOW GROVE PA
19090-1709
US

V. Phone/Fax

Practice location:
  • Phone: 215-657-6776
  • Fax: 267-913-5961
Mailing address:
  • Phone: 215-657-6776
  • Fax: 267-913-5961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD027056E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: KESHA NICOLE HARRIS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 215-657-6776