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General NPI Number Information
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NPI Number | 1164684601
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Entity Type | Organization
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Legal Business Name | MT AIRY/ GERMANTOWN MEDICAL AND REHAB ASSOCIATES
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 5751 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19141-2307
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Country | US
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Telephone | 215-843-0672
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Fax | 215-843-0674
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Provider Business Mailing Address
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Address Line | 5751 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19141-2307
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Country | US
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Telephone | 215-843-0672
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Fax | 215-843-0674
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | MR. GEORGE EDWARD FISHER
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Credential | M.D.
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Telephone | 215-843-0672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD061558L
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License Number State | PA
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