Provider Demographics
NPI:1912033093
Name:ARIA HEALTH PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:ARIA HEALTH PHYSICIAN SERVICES
Other - Org Name:ARIA HEALTH PHYSICIAN SERVICES - NORTHEAST INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-612-4823
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-969-3775
Practice Address - Street 1:2451 GRANT AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1004
Practice Address - Country:US
Practice Address - Phone:215-969-1500
Practice Address - Fax:215-969-3775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007526250041Medicaid
PA379886OtherHIGHMARK BLUE SHIELD
PA1007526250039Medicaid
PA1007526250051Medicaid
PA1024563OtherKEYSTONE MERCY
PA379886OtherPERSONAL CHOICE
PA0179761007OtherKEYSTONE,IBC
PA03315OtherHEALTH PARTNERS
PA301OtherAETNA
PA=========OtherTAX ID
PA179943Medicare PIN