Provider Demographics
NPI:1801841739
Name:PENNSYLVANIA RHEUMATOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PENNSYLVANIA RHEUMATOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-829-5358
Mailing Address - Street 1:822 PINE ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6187
Mailing Address - Country:US
Mailing Address - Phone:215-829-5358
Mailing Address - Fax:215-923-6442
Practice Address - Street 1:822 PINE ST STE 3A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6187
Practice Address - Country:US
Practice Address - Phone:215-829-5358
Practice Address - Fax:215-923-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120686Medicare ID - Type Unspecified