MEDICARE: CORE PERFORMANCE PHYSICIANS, 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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1518366517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE PERFORMANCE PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	1200 CONSTITUTION AVE
Second Line	:	SUITE 110
City	:	PHILADELPHIA
State	:	PA
Zip	:	19112-1329
Country	:	US
Telephone Number	:	267-592-3200
Fax Number	:	888-393-3980

Provider Business Practice Location Address
First Line	:	1200 CONSTITUTION AVE
Second Line	:	SUITE 110
City	:	PHILADELPHIA
State	:	PA
Zip	:	19112-1329
Country	:	US
Telephone Number	:	267-592-3200
Fax Number	:	888-393-3980

Authorized Official
Title or Position	:	CEO
Name	:	MS. ANN MARIE O'SHEA
Credential	:
Telephone Number	:	267-592-3200

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	08/15/2014

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