Organization
MAENPAA SPORTS MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARATH ALAN MAENPAA MD (OWNER)
(610) 209-2912
Entity
Organization
Contact information
Practice address
829 SPRUCE ST, SUITE308, PHILADELPHIA, PA 19107-5752
(215) 334-5346
Mailing address
486 KING AVE, COLLINGSWOOD, NJ 08108-1430
(610) 209-2912
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
MD073775-L
PA
Other
Enumeration date
11/02/2010
Last updated
01/04/2011
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