Provider Demographics
NPI:1598800518
Name:ARIA HEALTH PHYSICIAN SERVICES -OTOLARYNGOLOGY
Entity Type:Organization
Organization Name:ARIA HEALTH PHYSICIAN SERVICES -OTOLARYNGOLOGY
Other - Org Name:NORTHEAST ENT AT TORRESDALE
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:215-612-5658
Practice Address - Street 1:3998 RED LION RD STE 211
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1440
Practice Address - Country:US
Practice Address - Phone:215-612-5390
Practice Address - Fax:215-612-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007526250039Medicaid
PA1007526250041Medicaid
PACC4831OtherRAILROAD MEDICARE
PA2952901OtherAETNA HMO
PA2620890000OtherKEYSTONE IBC
PA30027496OtherKEYSTONE MERCY
PA1783156OtherHIGHMARK BLUE SHIELD
PA4360702OtherAETNA PPO
PA1783156OtherPERSONAL CHOICE
PA1007526250051Medicaid
PA36045OtherHEALTH PARTNERS
PA30027496OtherKEYSTONE MERCY