MEDICARE: EXECUTIVE HEALTH RESOURCES CLINICAL STAFFING SOLUTIONS 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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1660744	OTHER	PA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225067424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXECUTIVE HEALTH RESOURCES CLINICAL STAFFING SOLUTIONS PC

Provider Business Mailing Address
First Line	:	15 CAMPUS BLVD
Second Line	:	SUITE 200
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-3200
Country	:	US
Telephone Number	:	484-454-6268
Fax Number	:	610-789-6158

Provider Business Practice Location Address
First Line	:	15 CAMPUS BLVD
Second Line	:	SUITE 200
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-3200
Country	:	US
Telephone Number	:	484-454-6268
Fax Number	:	610-789-6158

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT CORRATO
Credential	:	M.D.
Telephone Number	:	484-454-6262

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	04/20/2008

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