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Organization

MERCY MANAGEMENT OF SEPA

Active
Other names
MMS-Leon Clarke, 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 537, PHILADELPHIA, PA 19143-1900
(215) 748-9653
(215) 748-9667
Mailing address
1 W ELM ST, 2 ND 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
1007787930154
PA
01
125182900
OWCP
PA
01
1542222
BLUE SHIELD
PA
01
2227092000
KEYSTONE HEALTH PLAN EAST
PA
01
30010808
KEYSTONE MERCY HEALTH PLA
PA
01
3032802
AETNA HMO
PA
01
4597364
AETNA PPO
PA
Enumeration date
12/20/2005
Last updated
06/16/2008
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