=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134184468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARIA HEALTH PHYSICIAN SERVICES-SURGERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 11/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3998 RED LION RD SUITE 235
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19114-1436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-632-3630
-----------------------------------------------------
Fax | 215-632-3544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ARIA HEALTH PHYSICIAN SERVICES P. O. BOX 8500 - 6335
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19178-6335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-807-8000
-----------------------------------------------------
Fax | 215-807-8235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SUSAN ABRAHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-612-4823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208C00000X
-----------------------------------------------------
Taxonomy Name | Colon & Rectal Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0102X
-----------------------------------------------------
Taxonomy Name | Surgical Critical Care Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------