Provider Demographics
NPI:1972592392
Name:FAITH MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:FAITH MEDICAL ASSOCIATES, INC
Other - Org Name:JENKINTOWN INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANU
Authorized Official - Middle Name:R
Authorized Official - Last Name:KONAKANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-887-9840
Mailing Address - Street 1:261 OLD YORK RD
Mailing Address - Street 2:STE 304
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3709
Mailing Address - Country:US
Mailing Address - Phone:215-887-9840
Mailing Address - Fax:218-887-9842
Practice Address - Street 1:261 OLD YORK RD
Practice Address - Street 2:STE 304
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3709
Practice Address - Country:US
Practice Address - Phone:215-887-9840
Practice Address - Fax:218-887-9842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055549L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA776565Medicare PIN