Provider Demographics
NPI:1124011283
Name:PULMONARY ASSOCIATES OF DREXEL HILL, PC
Entity type:Organization
Organization Name:PULMONARY ASSOCIATES OF DREXEL HILL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-394-9860
Mailing Address - Street 1:2100 KEYSTONE AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1129
Mailing Address - Country:US
Mailing Address - Phone:610-394-9860
Mailing Address - Fax:610-394-9922
Practice Address - Street 1:2100 KEYSTONE AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1129
Practice Address - Country:US
Practice Address - Phone:610-394-9860
Practice Address - Fax:610-394-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011579070007Medicaid
PA0011579070007Medicaid