Organization
PRIMARY CARE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN BRIGLIO (OFFICE MANAGER)
(215) 634-8000
Entity
Organization
Contact information
Practice address
2236 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-3830
(215) 634-8000
(215) 634-1760
Mailing address
2236 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-3830
(215) 634-8000
(215) 634-1760
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0538478
AETNA HMO
PA
01
—
0865743001
KEYSTONE EAST
PA
01
—
1026412
KEYSTONE MERCY
PA
Enumeration date
06/01/2006
Last updated
08/22/2020
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