Provider Demographics
NPI:1164484853
Name:PRIVOROTSKY, GALINA (MD)
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:PRIVOROTSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10125 VERREE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3611
Mailing Address - Country:US
Mailing Address - Phone:215-552-9060
Mailing Address - Fax:215-552-9065
Practice Address - Street 1:10125 VERREE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3611
Practice Address - Country:US
Practice Address - Phone:215-552-9060
Practice Address - Fax:215-552-9065
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043352E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
6633362001OtherCIGNA
2949093OtherAETNA
PA30002272OtherMERCY
PAE36337OtherHEALTH PARTNERS
PA0416948001OtherIBC
PA30002273OtherMERCY
3Y2330OtherHEALTHNET
139131OtherAETNA
PA32926OtherHEALTH PARTNERS
PA0013962900007Medicaid
PA0416948000OtherIBC
PA2119884001OtherIBC
4128231OtherAETNA
0282317016OtherCIGNA
P3037399OtherOXFORD
PA30002273OtherMERCY
PA0013962900007Medicaid