Provider Demographics
NPI:1134511157
Name:ROXBOROUGH MEDICAL OF ANDORRA LLC
Entity Type:Organization
Organization Name:ROXBOROUGH MEDICAL OF ANDORRA LLC
Other - Org Name:ROXBOROUGH EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAREKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-487-4244
Mailing Address - Street 1:5800 RIDGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2111
Mailing Address - Country:US
Mailing Address - Phone:215-487-4244
Mailing Address - Fax:215-487-4274
Practice Address - Street 1:8500 HENRY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2111
Practice Address - Country:US
Practice Address - Phone:267-766-6321
Practice Address - Fax:267-766-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030079750001Medicaid