Provider Demographics
NPI:1558387951
Name:LARCHWOOD MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:LARCHWOOD MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-528-5288
Mailing Address - Street 1:501 S 54TH ST
Mailing Address - Street 2:STE 227
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1900
Mailing Address - Country:US
Mailing Address - Phone:215-528-5288
Mailing Address - Fax:215-528-5033
Practice Address - Street 1:501 S 54TH ST
Practice Address - Street 2:STE 227
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:215-528-5288
Practice Address - Fax:215-528-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019877E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0688521Medicaid
PA0674187001OtherKEYSTONE
PA0054772000OtherBLUE CROSS BLUE SHIELD
PA0688521Medicaid
PAC0044055Medicare ID - Type Unspecified