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General NPI Number Information
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NPI Number | 1861434680
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA FAMILY MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4702 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19120-4108
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Country | US
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Telephone | 215-329-4888
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Fax | 215-329-5615
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Provider Business Mailing Address
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Address Line | 4702 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19120-4108
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Country | US
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Telephone | 215-329-4888
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Fax | 215-329-5615
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN WALSH
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Credential | D.O.
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Telephone | 215-329-4888
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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 | OS006489L
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License Number State | PA
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