=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568420495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILADELPHIA HEALTH ASSOCIATES - ADULT MEDICINE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2006
-----------------------------------------------------
Last Update Date | 10/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1740 SOUTH STREET SUITE 300
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19146-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-732-0876
-----------------------------------------------------
Fax | 215-732-1383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1740 SOUTH ST STE 402
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19146-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-732-0876
-----------------------------------------------------
Fax | 215-732-4162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILBERT ROY WARREN
-----------------------------------------------------
Credential | MD FACP
-----------------------------------------------------
Telephone | 215-732-0876
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------