MEDICARE: JOYCE MATHAI P.A.

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	363A00000X	Physician Assistant	MA055422	PA

General Provider Information

NPI Number	:	1093141400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE MATHAI P.A.

Provider Business Mailing Address
First Line	:	3223 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5007
Country	:	US
Telephone Number	:	215-707-5437
Fax Number	:	215-707-5180

Provider Business Practice Location Address
First Line	:	2450 W HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1302
Country	:	US
Telephone Number	:	215-707-5437
Fax Number	:	215-707-5180

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

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	12/20/2016

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