MEDICARE: MEDICAL ASSOCIATES OF BRIDESBURG

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	207Q00000X	Family Medicine Physician	OS005625L	PA

General Provider Information

NPI Number	:	1699817056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL ASSOCIATES OF BRIDESBURG

Provider Business Mailing Address
First Line	:	4517 E THOMPSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19137-2003
Country	:	US
Telephone Number	:	215-535-1275
Fax Number	:	215-535-8690

Provider Business Practice Location Address
First Line	:	4517 E THOMPSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19137-2003
Country	:	US
Telephone Number	:	215-535-1275
Fax Number	:	215-535-8690

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN BERNOT KIMMEL
Credential	:	DO
Telephone Number	:	215-535-1275

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	03/04/2008

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