=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104014042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARIA HEALTH PHYSICIAN SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2007
-----------------------------------------------------
Last Update Date | 07/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9892 BUSTLETON AVE MOSS PLAZA - SUITE 206
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19115-2184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-673-0343
-----------------------------------------------------
Fax | 215-464-6522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8500-6335
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19178-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-807-8000
-----------------------------------------------------
Fax | 215-464-6522
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SUSAN ABRAHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-612-4823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208C00000X
-----------------------------------------------------
Taxonomy Name | Colon & Rectal Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------