MEDICARE: M D COMPANY, INC.

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	3336C0003X	Community/Retail Pharmacy	PP411628L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3929277	OTHER		NCPDP
3	393805	OTHER	PA	PACE PROGRAM

General Provider Information

NPI Number	:	1023185147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M D COMPANY, INC.

Provider Business Mailing Address
First Line	:	1641 N FRANKLIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-2903
Country	:	US
Telephone Number	:	215-763-1875
Fax Number	:	215-235-6897

Provider Business Practice Location Address
First Line	:	1641 N FRANKLIN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-2903
Country	:	US
Telephone Number	:	215-763-1875
Fax Number	:	215-235-6897

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARK MOGIL
Credential	:	MCRP
Telephone Number	:	215-763-1875

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	02/25/2008

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Directions to “M D COMPANY, INC. ” Practice Location

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