MEDICARE: ELITE MEDICAL ASSOCIATES, P.C.

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	207Q00000X	Family Medicine Physician	MD067085L	PA

General Provider Information

NPI Number	:	1043731102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE MEDICAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	2020 PENROSE AVE STE A1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-5763
Country	:	US
Telephone Number	:	215-517-5050
Fax Number	:	215-517-4105

Provider Business Practice Location Address
First Line	:	2020 PENROSE AVE STE A1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-5763
Country	:	US
Telephone Number	:	215-517-5050
Fax Number	:	215-517-4105

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL RONALD MCCOY
Credential	:	MD
Telephone Number	:	215-991-9006

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	07/21/2022

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