MEDICARE: KEYSTONE MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	225100000X	Physical Therapist
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1003244419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1220 BRIDLE ESTATES DR
Second Line	:
City	:	YARDLEY
State	:	PA
Zip	:	19067-3957
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 WELSH RD
Second Line	:	SUITE 201
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2213
Country	:	US
Telephone Number	:	215-914-5122
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BINOY CHERIAN
Credential	:
Telephone Number	:	215-914-5122

Provider Enumeration Date	:	10/22/2013
Last Update Date	:	10/22/2013

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Directions to “KEYSTONE MEDICAL GROUP ” Practice Location

Language	Start Address	Practice Location

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