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General NPI Number Information
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NPI Number | 1750194569
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Entity Type | Organization
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Legal Business Name | PENNMED CARE PA PC
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 841 E HUNTING PARK AVE STE 110
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City | PHILADELPHIA
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State | PA
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Zip | 19124-4813
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Country | US
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Telephone | 215-709-3800
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Fax | 215-476-1427
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Provider Business Mailing Address
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Address Line | PO BOX 9369
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City | PHILADELPHIA
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State | PA
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Zip | 19139-9369
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Country | US
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Telephone | 215-709-3800
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Fax | 215-476-1427
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHN MANZELLA
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Credential | DO
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Telephone | 215-709-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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