MEDICARE: BALMONT FAMILY PRACTICE GROUP P.C.

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	OS007190L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000489382	OTHER	PA	IBC BLUE SHIELD ID

General Provider Information

NPI Number	:	1780806422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALMONT FAMILY PRACTICE GROUP P.C.

Provider Business Mailing Address
First Line	:	5008 BALTIMORE AVE STE A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4271
Country	:	US
Telephone Number	:	215-764-8520
Fax Number	:	215-764-8521

Provider Business Practice Location Address
First Line	:	5008 BALTIMORE AVE
Second Line	:	SUITE A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-3302
Country	:	US
Telephone Number	:	215-764-8520
Fax Number	:	215-764-8521

Authorized Official
Title or Position	:	PROVIDER
Name	:	TERRENCE MICHAEL CURLEY
Credential	:
Telephone Number	:	215-764-8520

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	11/24/2025

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