Organization
HR PHYSICIAN SERVICES
Active
Other names
Somerton Family Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL R. WAGNER (EXECUTIVE VICE PRESIDENT, FINANCE)
(215) 856-1114
Entity
Organization
Contact information
Practice address
23 BUSTLETON AVENUE, SUITE 100, FEASTERVILLE, PA 19053
(215) 464-9599
(215) 464-7865
Mailing address
PO BOX 8500, BOX #4801, PHILADELPHIA, PA 19178-4081
(215) 856-1010
(215) 464-7865
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
232523377
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0098660
AETNA US HEALTHCARE
PA
01
—
0391360001
KEYSTONE HEALTH PLAN EAST
PA
05
—
100416
—
PA
Enumeration date
09/14/2005
Last updated
12/01/2016
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