MEDICARE: CHESTNUT HILL MEDICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
2	208M00000X	Hospitalist Physician
3	207RP1001X	Pulmonary Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	377472	OTHER	PA	HIGHMARK BLUE SHIELD
2	0182138000	OTHER	PA	INDEPENDENCE BLUE CROSS
3	53625	OTHER	PA	AETNA
4	1000166	OTHER	PA	KEYSTONE MERCY
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275589103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESTNUT HILL MEDICAL

Provider Business Mailing Address
First Line	:	8815 GERMANTOWN AVE
Second Line	:	SUITE 12
City	:	PHILA
State	:	PA
Zip	:	19118-2722
Country	:	US
Telephone Number	:	215-247-8070
Fax Number	:	215-242-8142

Provider Business Practice Location Address
First Line	:	7810 NAVAJO ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19118-4015
Country	:	US
Telephone Number	:	215-247-8070
Fax Number	:	215-242-8142

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KATHY CERULLI
Credential	:
Telephone Number	:	215-247-8070

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	09/24/2010

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Directions to “CHESTNUT HILL MEDICAL ” Practice Location

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