Organization
MERCY MANAGEMENT OF SEPA
Active
Other names
SEPA Multi - Specialty Group
Organization subpart
No
Provider details
NPI number
Authorized official
AMIEE BRENNAN (CREDENTIALING SUPERVISOR)
(610) 567-6964
Entity
Organization
Contact information
Practice address
501 S 54TH ST STE 186, PHILADELPHIA, PA 19143-1900
(215) 748-9530
(215) 748-9199
Mailing address
1 W ELM ST, CONSHOHOCKEN, PA 19428-4108
(610) 567-6964
(610) 567-5420
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207RX0202X
Medical Oncology Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207VG0400X
Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
208600000X
Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Enumeration date
08/03/2017
Last updated
03/17/2018
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