Provider Demographics
NPI:1912371048
Name:CORE PERFORMANCE PHYSICIANS
Entity type:Organization
Organization Name:CORE PERFORMANCE PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-592-3200
Mailing Address - Street 1:1200 CONSTITUTION AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19112-1329
Mailing Address - Country:US
Mailing Address - Phone:267-592-3200
Mailing Address - Fax:888-393-3980
Practice Address - Street 1:1200 CONSTITUTION AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1329
Practice Address - Country:US
Practice Address - Phone:267-592-3200
Practice Address - Fax:888-393-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4429232084P2900X
PAMD437907208600000X
PASP015772363LF0000X
PAMD072993L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty