MEDICARE: HOME MD 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1629501960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME MD PC

Provider Business Mailing Address
First Line	:	3510 SUNSET WAY
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-7749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 SUNSET WAY
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-7749
Country	:	US
Telephone Number	:	215-808-0089
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	YEVGENIYA MAZUR
Credential	:
Telephone Number	:	215-808-0089

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/04/2017

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