MEDICARE: IHP PA EMERGENCY MEDICINE PLLC

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1104664499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IHP PA EMERGENCY MEDICINE PLLC

Provider Business Mailing Address
First Line	:	610 SENTRY PKWY STE 102
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-2314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 DEKALB PIKE STE 301
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19401-2007
Country	:	US
Telephone Number	:	856-294-8435
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	WILLIAM VEMULA
Credential	:	MD
Telephone Number	:	856-294-8435

Provider Enumeration Date	:	07/19/2024
Last Update Date	:	07/19/2024

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