MEDICARE: PHILADELPHIA HEALTH ASSOCIATES - ADULT MEDICINE, P.C.

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	207R00000X	Internal Medicine 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

General Provider Information

NPI Number	:	1568420495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA HEALTH ASSOCIATES - ADULT MEDICINE, P.C.

Provider Business Mailing Address
First Line	:	1740 SOUTH ST STE 402
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1514
Country	:	US
Telephone Number	:	215-732-0876
Fax Number	:	215-732-4162

Provider Business Practice Location Address
First Line	:	1740 SOUTH STREET
Second Line	:	SUITE 300
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1514
Country	:	US
Telephone Number	:	215-732-0876
Fax Number	:	215-732-1383

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILBERT ROY WARREN
Credential	:	MD FACP
Telephone Number	:	215-732-0876

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	10/14/2024

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