Organization
INESSA BINIAURISHVILI,M.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. INESSA G. BINIAURISHVILI M.D. (CEO)
(215) 464-7820
Entity
Organization
Contact information
Practice address
11685C BUSTLETON AVENUE, HENDRIX CENTER, PHILADELPHIA, PA 19116
(215) 464-7820
(215) 464-7808
Mailing address
26 LEEMAR DR, SOUTHAMPTON, PA 18966-1114
(215) 942-0234
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD061863-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016575930004
—
PA
Enumeration date
09/04/2009
Last updated
09/04/2009
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