MEDICARE: TOWER DREXEL ACADEMIC MEDICAL GROUP LLC

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1841833548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWER DREXEL ACADEMIC MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 13579
Second Line	:
City	:	READING
State	:	PA
Zip	:	19612-3579
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 SHURS LN STE 203
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2123
Country	:	US
Telephone Number	:	215-482-1234
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BRIAN RAYME
Credential	:
Telephone Number	:	443-377-0616

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	01/14/2026

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