Organization
MERCY MANAGEMENT OF SEPA
Active
Other names
MMS-John Fobia, MD
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS C SMITH (VP FINANCIAL SERVICES)
(610) 567-6964
Entity
Organization
Contact information
Practice address
501 S 54TH ST, SUITE 227, PHILADELPHIA, PA 19143-1900
(215) 748-9653
(215) 748-9667
Mailing address
1 W ELM ST, 2ND FLOOR, CONSHOHOCKEN, PA 19428-2007
(610) 567-6964
(610) 567-6170
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007787930158
—
PA
01
—
2229022000
KEYSTONE HEALTH PLAN EAST
PA
01
—
2610916
AETNA HMO
PA
01
—
30011086
KEYSTONE MERCY
PA
01
—
4100588
AETNA PPO
PA
01
—
BLUE SHIELD
1544375
PA
Enumeration date
12/21/2005
Last updated
01/31/2008
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