MEDICARE: JOHN AVERY SALVIA PA

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	363A00000X	Physician Assistant	MA001143L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA001143L	OTHER	PA	LICENSE NUMBER

General Provider Information

NPI Number	:	1689717860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN AVERY SALVIA PA

Provider Business Mailing Address
First Line	:	1 MEDICAL CENTER BLVD
Second Line	:	STE 300
City	:	CHESTER
State	:	PA
Zip	:	19013-3902
Country	:	US
Telephone Number	:	610-447-2000
Fax Number	:	610-447-6606

Provider Business Practice Location Address
First Line	:	1703 S BROAD ST
Second Line	:	STE 300
City	:	PHILA
State	:	PA
Zip	:	19148-1536
Country	:	US
Telephone Number	:	215-462-7100
Fax Number	:	215-463-3820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	04/06/2016

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Directions to “ JOHN AVERY SALVIA PA” Practice Location

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