Provider Demographics
NPI:1275589103
Name:CHESTNUT HILL MEDICAL
Entity Type:Organization
Organization Name:CHESTNUT HILL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CERULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-247-8070
Mailing Address - Street 1:8815 GERMANTOWN AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2722
Mailing Address - Country:US
Mailing Address - Phone:215-247-8070
Mailing Address - Fax:215-242-8142
Practice Address - Street 1:7810 NAVAJO ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19118-4015
Practice Address - Country:US
Practice Address - Phone:215-247-8070
Practice Address - Fax:215-242-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA377472OtherHIGHMARK BLUE SHIELD
PA0182138000OtherINDEPENDENCE BLUE CROSS
PA53625OtherAETNA
PA1000166OtherKEYSTONE MERCY
PA0017215400003Medicaid
PA53625OtherAETNA