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General NPI Number Information
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NPI Number | 1699817056
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Entity Type | Organization
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Legal Business Name | MEDICAL ASSOCIATES OF BRIDESBURG
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 4517 E THOMPSON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19137-2003
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Country | US
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Telephone | 215-535-1275
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Fax | 215-535-8690
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Provider Business Mailing Address
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Address Line | 4517 E THOMPSON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19137-2003
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Country | US
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Telephone | 215-535-1275
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Fax | 215-535-8690
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN BERNOT KIMMEL
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Credential | DO
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Telephone | 215-535-1275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS005625L
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License Number State | PA
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