Provider Demographics
NPI:1114257979
Name:ARIA HEALTH PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:ARIA HEALTH PHYSICIAN SERVICES
Other - Org Name:ARIA HEALTH PHYSICIAN SERVICES - PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-612-4858
Mailing Address - Street 1:PO BOX 825395
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5395
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-612-2630
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:SUITE 304
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4060
Practice Address - Fax:215-612-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1896336OtherPERSONAL CHOICE
PA2765495000OtherKEYSTONE
PA30002901OtherKEYSTONE MERCY
PA1007526250039Medicaid
PA1896336OtherBLUE SHIELD
PA8495883OtherAETNA PPO
PA3056461OtherAETNA HMO
PA2765495000OtherKEYSTONE