=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316072077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARIA HEALTH PHYSICIAN SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 10/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9501 ROOSEVELT BLVD SUITE 206-B
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19114-1025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-671-8900
-----------------------------------------------------
Fax | 215-671-1272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 825395
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19182-5395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-671-8900
-----------------------------------------------------
Fax | 215-671-1272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR VICE PRESIDENT
-----------------------------------------------------
Name | RONALD M. KUMOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-612-4858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------