MEDICARE: TACONY FAMILY MEDICINE 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

General Provider Information

NPI Number	:	1366504383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TACONY FAMILY MEDICINE PC

Provider Business Mailing Address
First Line	:	6826 TORRESDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-2314
Country	:	US
Telephone Number	:	215-335-1110
Fax Number	:	215-335-9733

Provider Business Practice Location Address
First Line	:	6826 TORRESDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-2314
Country	:	US
Telephone Number	:	215-335-1110
Fax Number	:	215-335-9733

Authorized Official
Title or Position	:	PRESIDENT AND PHYSICIAN
Name	:	DR. MARIANNE COLVIN
Credential	:	D.O.
Telephone Number	:	215-335-1110

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	08/22/2020

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