Provider Demographics
NPI:1720727027
Name:PENN MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:PENN MEDICAL ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFFI
Authorized Official - Middle Name:
Authorized Official - Last Name:BARSOUMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-874-7006
Mailing Address - Street 1:681 ORANGEBURGH RD
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6404
Mailing Address - Country:US
Mailing Address - Phone:516-287-1120
Mailing Address - Fax:
Practice Address - Street 1:1608 WALNUT ST.
Practice Address - Street 2:SUITE 1701A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5415
Practice Address - Country:US
Practice Address - Phone:516-287-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENN MEDICAL ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-03
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty