MEDICARE: CRICKET MEDICAL ASSOCIATES LTD

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1043511306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRICKET MEDICAL ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	39 E CHESTNUT HILL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2728
Country	:	US
Telephone Number	:	215-248-5600
Fax Number	:	215-242-0160

Provider Business Practice Location Address
First Line	:	39 E CHESTNUT HILL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2728
Country	:	US
Telephone Number	:	215-248-5600
Fax Number	:	215-242-0160

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GERALD R PHELAN
Credential	:	MD
Telephone Number	:	215-248-5600

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	02/18/2011

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