MEDICARE: DEBRADY, AKILI MD PC

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	MD428354	PA

General Provider Information

NPI Number	:	1205043304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRADY, AKILI MD PC

Provider Business Mailing Address
First Line	:	7601 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1608
Country	:	US
Telephone Number	:	215-248-6090
Fax Number	:	215-248-6091

Provider Business Practice Location Address
First Line	:	7601 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1608
Country	:	US
Telephone Number	:	215-248-6090
Fax Number	:	215-248-6091

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AKILI H DEBRADY
Credential	:	MD
Telephone Number	:	215-248-6090

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/24/2009

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