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General NPI Number Information
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NPI Number | 1528485828
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Entity Type | Organization
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Legal Business Name | BOSTON MEDICAL GROUP PENNSYLVANIA, P.C.
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 100 S. BROAD STREET SUITE 2136
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City | PHILADELPHIA
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State | PA
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Zip | 19110
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Country | US
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Telephone | 215-972-7090
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Fax | 215-972-7097
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Provider Business Mailing Address
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Address Line | 100 S. BROAD STREET SUITE 2136
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City | PHILADELPHIA
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State | PA
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Zip | 19110
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Country | US
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Telephone | 215-972-7090
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Fax | 215-972-7097
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MS. MARIANNE C. LABARBERA
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Credential | M.D.
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Telephone | 718-981-4070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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