Provider Demographics
NPI:1396713897
Name:PHILADELPHIA REHAB MEDC
Entity type:Organization
Organization Name:PHILADELPHIA REHAB MEDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:ARAVA
Authorized Official - Last Name:BHUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-722-5305
Mailing Address - Street 1:7720 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3602
Mailing Address - Country:US
Mailing Address - Phone:215-722-1525
Mailing Address - Fax:215-722-7819
Practice Address - Street 1:7720 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3602
Practice Address - Country:US
Practice Address - Phone:215-722-1525
Practice Address - Fax:215-722-7819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-019689-E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077541Medicare PIN