# NAZARETH PHYSICIAN SERVICES INC

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

## Provider details

- **NPI number:** 1538190137
- **Authorized official:** MR. DAVID WAJDA (CFO)
- **Authorized official phone:** (215) 335-6614

## Contact information

- **Practice address:** 2601 HOLME AVE, PHILADELPHIA, PA 19152-2007
- **Practice address phone:** (215) 350-7417
- **Practice address fax:** (215) 335-6303
- **Mailing address:** 1 W ELM ST, SUITE 100, CONSHOHOCKEN, PA 19428-4108
- **Mailing address phone:** (610) 567-6967

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 04/01/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 101465514 0001 | — | PA |
| 01 | — | 2457876000 | IBC\# | PA |
| 01 | — | 425807 | AETNA OFFICE \# | PA |
| 01 | — | NA1775677 | HIGHMARK BLUE SHIELD | PA |