MEDICARE: EASTERN PENNSYLVANIA INFECTIOUS DISEASE ASSOCIATES, 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	207RI0200X	Infectious Disease Physician	MD069250L	PA

General Provider Information

NPI Number	:	1588717565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN PENNSYLVANIA INFECTIOUS DISEASE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	170 N HENDERSON RD STE 310
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-2155
Country	:	US
Telephone Number	:	610-481-9600
Fax Number	:	610-481-0225

Provider Business Practice Location Address
First Line	:	649 N LEWIS RD STE 220
Second Line	:
City	:	LIMERICK
State	:	PA
Zip	:	19468-1234
Country	:	US
Telephone Number	:	610-481-9600
Fax Number	:

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	TARA J NAKOA
Credential	:
Telephone Number	:	610-596-4220

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	11/18/2025

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