MEDICARE: MR. ROBERT RADOMILE M.ED

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	103T00000X	Psychologist	PS004718L	PA

General Provider Information

NPI Number	:	1861619769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT RADOMILE M.ED

Provider Business Mailing Address
First Line	:	24 LINDA LN
Second Line	:
City	:	ASTON
State	:	PA
Zip	:	19014-1870
Country	:	US
Telephone Number	:	215-698-8910
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 WELSH RD
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-4213
Country	:	US
Telephone Number	:	215-698-8910
Fax Number	:	215-698-8946

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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