MEDICARE: MRS. ROBERTA VIRGINIA TURNER M.D.

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	207R00000X	Internal Medicine Physician	MD033619E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	232664784	OTHER	PA	TAX ID

General Provider Information

NPI Number	:	1831130244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBERTA VIRGINIA TURNER M.D.

Provider Business Mailing Address
First Line	:	101 E OLNEY AVE
Second Line	:	SUITE 400
City	:	PHILA
State	:	PA
Zip	:	19120-2421
Country	:	US
Telephone Number	:	215-456-7000
Fax Number	:	215-254-2599

Provider Business Practice Location Address
First Line	:	5401 OLD YORK RD
Second Line	:	KLEIN 331
City	:	PHILA
State	:	PA
Zip	:	19141-3030
Country	:	US
Telephone Number	:	215-456-6527
Fax Number	:	215-455-1933

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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