MEDICARE: METRO PHYSICAL MEDICINE GROUP INC.

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	208100000X	Physical Medicine & Rehabilitation Physician

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
2	2880704	OTHER	PA	BCBS

General Provider Information

NPI Number	:	1427428903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO PHYSICAL MEDICINE GROUP INC.

Provider Business Mailing Address
First Line	:	2913-15 NTH 22ND
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-2009
Country	:	US
Telephone Number	:	215-422-3140
Fax Number	:

Provider Business Practice Location Address
First Line	:	2913 N 22ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-1505
Country	:	US
Telephone Number	:	215-613-4126
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JOE COLE
Credential	:
Telephone Number	:	215-422-3140

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	05/20/2016

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Directions to “METRO PHYSICAL MEDICINE GROUP INC. ” Practice Location

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