Organization
CHESTNUT HILL MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY CERULLI (OFFICE MANAGER)
(215) 247-8070
Entity
Organization
Contact information
Practice address
7810 NAVAJO ST, PHILA, PA 19118-4015
(215) 247-8070
(215) 242-8142
Mailing address
8815 GERMANTOWN AVE, SUITE 12, PHILA, PA 19118-2722
(215) 247-8070
(215) 242-8142
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017215400003
—
PA
01
—
0182138000
INDEPENDENCE BLUE CROSS
PA
01
—
1000166
KEYSTONE MERCY
PA
01
—
377472
HIGHMARK BLUE SHIELD
PA
01
—
53625
AETNA
PA
Enumeration date
05/25/2006
Last updated
09/24/2010
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