MEDICARE: MS. CARMELLA DIANE MOREGRASS PHLEBOTOMIST

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	246RP1900X	Phlebotomy Technician		PA

General Provider Information

NPI Number	:	1114118627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARMELLA DIANE MOREGRASS PHLEBOTOMIST

Provider Business Mailing Address
First Line	:	1432 S 56TH STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143
Country	:	US
Telephone Number	:	215-729-2019
Fax Number	:	215-729-2019

Provider Business Practice Location Address
First Line	:	1432 S 56TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4733
Country	:	US
Telephone Number	:	215-729-2019
Fax Number	:	215-729-2019

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

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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