MEDICARE: REVOLUTIONARY MENTAL HEALTH INC

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	2084P0802X	Addiction Psychiatry Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1821885815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVOLUTIONARY MENTAL HEALTH INC

Provider Business Mailing Address
First Line	:	1395 OAK LN
Second Line	:
City	:	QUAKERTOWN
State	:	PA
Zip	:	18951-3004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-7301
Country	:	US
Telephone Number	:	240-797-6869
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ROBIN CARDAN
Credential	:	MD
Telephone Number	:	240-797-6869

Provider Enumeration Date	:	04/22/2025
Last Update Date	:	04/22/2025

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