# ARIA HEALTH PHYSICIAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ARIA HEALTH PHYSICIAN SERVICES - CENTRAL SQUARE MEDICAL, Central Square Medical Center - Grant Ave
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316072077
- **Authorized official:** RONALD M. KUMOR (SENIOR VICE PRESIDENT)
- **Authorized official phone:** (215) 612-4858

## Contact information

- **Practice address:** 9501 ROOSEVELT BLVD, SUITE 206-B, PHILADELPHIA, PA 19114-1025
- **Practice address phone:** (215) 671-8900
- **Practice address fax:** (215) 671-1272
- **Mailing address:** PO BOX 825395, PHILADELPHIA, PA 19182-5395
- **Mailing address phone:** (215) 671-8900
- **Mailing address fax:** (215) 671-1272

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | PA | Yes |
| 207R00000X | Internal Medicine Physician | — | PA | — |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 10/12/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0200976001 | KEYSTONE, IBC | PA |
| 05 | — | 1007526250039 | — | PA |
| 05 | — | 1007526250041 | — | PA |
| 05 | — | 1007526250051 | — | PA |
| 01 | — | 10236 | HEALTH PARTNERS | PA |
| 01 | — | 1026492 | KEYSTONE MERCY | PA |
| 01 | — | 19933 | AETNA | PA |
| 01 | — | 379777 | HIGHMARK BLUE SHIELD | PA |