MEDICARE: DR. GREGORY JOSEPH TRAMUTA M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD-016856E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	159944	OTHER	PA	INDEPENDENCE BLUE CROSS

General Provider Information

NPI Number	:	1023069135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY JOSEPH TRAMUTA M.D.

Provider Business Mailing Address
First Line	:	8200 FLOURTOWN AVE
Second Line	:	SUITE 4B
City	:	WYNDMOOR
State	:	PA
Zip	:	19038-7976
Country	:	US
Telephone Number	:	215-233-1774
Fax Number	:	215-955-0150

Provider Business Practice Location Address
First Line	:	8200 FLOURTOWN AVE
Second Line	:	SUITE 4B
City	:	WYNDMOOR
State	:	PA
Zip	:	19038-7976
Country	:	US
Telephone Number	:	215-233-1774
Fax Number	:	215-955-0150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	07/09/2007

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