MEDICARE: ASHLEY O'MALLEY

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	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator

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

General Provider Information

NPI Number	:	1487841292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY O'MALLEY

Provider Business Mailing Address
First Line	:	3901 MARKET ST
Second Line	:	BOX 1934
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3133
Country	:	US
Telephone Number	:	215-387-6055
Fax Number	:	215-387-7989

Provider Business Practice Location Address
First Line	:	3901 MARKET ST
Second Line	:	BOX 1934
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3133
Country	:	US
Telephone Number	:	215-387-6055
Fax Number	:	215-387-7989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	12/26/2007

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Directions to “ ASHLEY O'MALLEY ” Practice Location

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