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General NPI Number Information
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NPI Number | 1689227209
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Entity Type | Organization
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Legal Business Name | MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANI
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 5901 MARKET ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3117
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Country | US
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Telephone | 413-262-6762
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Fax | 610-567-5495
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Provider Business Mailing Address
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Address Line | 41 UNIVERSITY DR STE 106
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City | NEWTOWN
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State | PA
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Zip | 18940-1873
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN CARUSO
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Credential |
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Telephone | 215-710-2651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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