Provider Demographics
NPI:1790979870
Name:ADVANCED FAMILY MEDICINE P.C.
Entity Type:Organization
Organization Name:ADVANCED FAMILY MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:TARNOPOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD,DO
Authorized Official - Phone:267-242-7993
Mailing Address - Street 1:14200 BUSTLETON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1186
Mailing Address - Country:US
Mailing Address - Phone:215-671-0900
Mailing Address - Fax:215-671-8114
Practice Address - Street 1:14200 BUSTLETON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1186
Practice Address - Country:US
Practice Address - Phone:215-671-0900
Practice Address - Fax:215-671-8114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010564L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care