MEDICARE: JOAN MUREEN ADDLEY DO

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	207QA0000X	Adolescent Medicine (Family Medicine) Physician	OS010055L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275532160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN MUREEN ADDLEY DO

Provider Business Mailing Address
First Line	:	41 UNIVERSITY DR STE 106
Second Line	:
City	:	NEWTOWN
State	:	PA
Zip	:	18940-1873
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8125 STENTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-3530
Country	:	US
Telephone Number	:	215-248-7560
Fax Number	:	215-248-7564

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	05/17/2021

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