Provider Demographics
NPI:1104014042
Name:ARIA HEALTH PHYSICIAN SERVICES
Entity type:Organization
Organization Name:ARIA HEALTH PHYSICIAN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-612-4823
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-464-6522
Practice Address - Street 1:9892 BUSTLETON AVE
Practice Address - Street 2:MOSS PLAZA - SUITE 206
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2184
Practice Address - Country:US
Practice Address - Phone:215-673-0343
Practice Address - Fax:215-464-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007526250039Medicaid
PA1007526250041Medicaid
PA1413853OtherHIGHMARK BLUE SHIELD
PA2952901OtherAETNA
PA01749OtherHEALTH PARTNERS
PA2101721000OtherKEYSTONE,IBC
PA1007526250051Medicaid
PA30001994OtherKEYSTONE MERCY
PA1007526250050Medicaid
PA1413853OtherPERSONAL CHOICE
PA2952901OtherAETNA