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General NPI Number Information
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NPI Number | 1801820741
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Entity Type | Organization
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Legal Business Name | SOUTH PHILADELPHIA FAMILY MEDICINE
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2243 S 9TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-3102
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Country | US
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Telephone | 215-334-4049
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Fax | 215-462-9722
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Provider Business Mailing Address
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Address Line | 3960 LANKENAU AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19131-2827
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Country | US
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Telephone | 215-334-4049
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Fax | 215-462-9722
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Authorized Official
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Title or Position | OWNER
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Name | MARIA MAZZOTTI
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Credential | DO
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Telephone | 215-334-4049
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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 | OS008840L
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License Number State | PA
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