MEDICARE: ADDICTION CONSULTANTS OF PENNSYLVANIA LLC

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	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1407612344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION CONSULTANTS OF PENNSYLVANIA LLC

Provider Business Mailing Address
First Line	:	717 S CHRISTOPHER COLUMBUS BLVD UNIT 1610
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3514
Country	:	US
Telephone Number	:	304-951-3599
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 CENTRAL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2442
Country	:	US
Telephone Number	:	304-951-3599
Fax Number	:

Authorized Official
Title or Position	:	ATTENDING PHYSICIAN
Name	:	SRIKRISHNA V MALAYALA
Credential	:	MD
Telephone Number	:	304-951-3599

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	01/13/2026

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