Provider Demographics
NPI:1770547499
Name:PHILADELPHIA HEALTH ASSOCIATES-PEDIATRICS, PC
Entity type:Organization
Organization Name:PHILADELPHIA HEALTH ASSOCIATES-PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-452-0304
Mailing Address - Street 1:25 BALA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3214
Mailing Address - Country:US
Mailing Address - Phone:215-452-0304
Mailing Address - Fax:215-452-0311
Practice Address - Street 1:25 BALA AVE STE 102
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3214
Practice Address - Country:US
Practice Address - Phone:215-452-0304
Practice Address - Fax:215-452-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD006904E208000000X
PAMD019870E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00616630Medicaid
PA01827862Medicaid
PA0763930Medicaid
PA01827862Medicaid
PA00616630Medicaid
C27313Medicare UPIN
PA047473Medicare ID - Type UnspecifiedGROUP NUMBER
PA130636Medicare ID - Type Unspecified