Provider Demographics
NPI:1962467241
Name:ARIA HEALTH PHYSICIAN SERVICES-GYN
Entity Type:Organization
Organization Name:ARIA HEALTH PHYSICIAN SERVICES-GYN
Other - Org Name:
Other - Org Type:
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:215-481-6836
Mailing Address - Fax:215-481-5788
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4143
Practice Address - Fax:215-612-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207V00000X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1159829OtherKEYSTONE MERCY
PA2807246OtherAETNA
PA1007526250039Medicaid
PA1007526250041Medicaid
PA1007526250051Medicaid
PA2073552000OtherKEYSTONE EAST
PA1382048OtherPERSONAL CHOICE
PA1382048OtherBLUE SHIELD
PA33630OtherHEALTH PARTNERS
PA=========OtherTAX ID
PA059382Medicare PIN