MEDICARE: PHILADELPHIA FAMILY MEDICNE ASSOC 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	OS009019L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912958638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA FAMILY MEDICNE ASSOC P.C.

Provider Business Mailing Address
First Line	:	1028 W OREGON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-4421
Country	:	US
Telephone Number	:	215-389-7766
Fax Number	:	215-389-0227

Provider Business Practice Location Address
First Line	:	1028 W OREGON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-4421
Country	:	US
Telephone Number	:	215-389-7766
Fax Number	:	215-389-0227

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH P DIRENZO JR.
Credential	:	D.O.
Telephone Number	:	215-389-7766

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/15/2021

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