MEDICARE: WISSINOMING MEDICAL ASSOCIATES 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	OS003680L	PA

General Provider Information

NPI Number	:	1487609210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISSINOMING MEDICAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	6122 TORRESDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-3718
Country	:	US
Telephone Number	:	215-338-6677
Fax Number	:	215-338-9935

Provider Business Practice Location Address
First Line	:	6122 TORRESDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-3718
Country	:	US
Telephone Number	:	215-338-6677
Fax Number	:	215-338-9935

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MITCHELL A SCHWARTZMAN
Credential	:	D.O.
Telephone Number	:	215-338-6677

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	12/11/2012

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