Provider Demographics
NPI:1073509212
Name:CINELLI, PHILIP J (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:CINELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1337 BLUE VALLEY DR
Practice Address - Street 2:SUITE 7
Practice Address - City:PEN ARGYL
Practice Address - State:PA
Practice Address - Zip Code:18072-1815
Practice Address - Country:US
Practice Address - Phone:610-654-1270
Practice Address - Fax:610-654-1271
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006283L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011306180001Medicaid
PA199089Medicare ID - Type Unspecified
PA0011306180001Medicaid