MEDICARE: SENIOR HEALTH ASSOCIATES

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	101301	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19033	OTHER	PA	HEALTH PARTNERS GROUP ID

General Provider Information

NPI Number	:	1669410387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR HEALTH ASSOCIATES

Provider Business Mailing Address
First Line	:	7604 CENTRAL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2433
Country	:	US
Telephone Number	:	215-742-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	7604 CENTRAL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2433
Country	:	US
Telephone Number	:	215-742-2100
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. GERALD P OETZEL
Credential	:
Telephone Number	:	215-728-3306

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/22/2020

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