Provider Demographics
NPI:1124069869
Name:PENNSYLVANIA PULMONARY MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:PENNSYLVANIA PULMONARY MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-829-5027
Mailing Address - Street 1:700 SPRUCE STREET
Mailing Address - Street 2:SUTE 500
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4027
Mailing Address - Country:US
Mailing Address - Phone:215-829-5027
Mailing Address - Fax:215-829-6391
Practice Address - Street 1:700 SPRUCE STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4027
Practice Address - Country:US
Practice Address - Phone:215-829-5027
Practice Address - Fax:215-829-6391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081822Medicare ID - Type Unspecified