# FOUNTAIN MEDICAL ASSOCIATES P C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215257837
- **Authorized official:** DR. SAFIYYA S SHABAZZ MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (215) 924-2440

## Contact information

- **Practice address:** 22 E MOUNT AIRY AVE, PHILADELPHIA, PA 19119
- **Practice address phone:** (215) 924-2440
- **Practice address fax:** (267) 437-2346
- **Mailing address:** 22 E MOUNT AIRY AVE, PHILADELPHIA, PA 19119-1712
- **Mailing address phone:** (215) 924-2440
- **Mailing address fax:** (267) 437-2346

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD428070 | PA | Yes |

## Other

- **Enumeration date:** 06/04/2010
- **Last updated:** 07/27/2018