Organization
DAVITA MEDICAL GROUP PHILADELPHIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J LIPP (SHAREHOLDER)
(844) 902-2345
Entity
Organization
Contact information
Practice address
2476 SWEDESFORD RD, #150, MALVERN, PA 19355-1456
(844) 902-2345
Mailing address
2476 SWEDESFORD RD, #150, MALVERN, PA 19355-1456
(844) 902-2345
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
11/22/2016
Last updated
05/11/2017
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