MEDICARE: 2126 FAIRMOUNT MEDICAL, INC.

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	:	1114972114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2126 FAIRMOUNT MEDICAL, INC.

Provider Business Mailing Address
First Line	:	2126 FAIRMOUNT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2603
Country	:	US
Telephone Number	:	215-236-4600
Fax Number	:	215-236-4609

Provider Business Practice Location Address
First Line	:	2126 FAIRMOUNT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2603
Country	:	US
Telephone Number	:	215-236-4600
Fax Number	:	215-236-4609

Authorized Official
Title or Position	:	PHYSICIAN CO-OWNER
Name	:	DR. FRANK JOSEPH MONDSCHEIN
Credential	:	MD
Telephone Number	:	215-236-4600

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/22/2020

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