Basic Information
| Provider Information | |||||||||
| NPI: | 1326094384 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE INTERNAL MEDICINE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7602 CENTRAL AVE | ||||||||
| Address2: | STAPELEY BLDG SUITE 101 | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191112443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159692900 | ||||||||
| FaxNumber: | 2159691856 | ||||||||
| Practice Location | |||||||||
| Address1: | 7602 CENTRAL AVE | ||||||||
| Address2: | STAPELEY BLDG SUITE 101 | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191112443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159692900 | ||||||||
| FaxNumber: | 2159691856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 02/11/2015 | ||||||||
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| AuthorizedOfficialLastName: | SNYDER | ||||||||
| AuthorizedOfficialFirstName: | COURTNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 2159692900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | CA7002 | 01 | RAILROAD MEDICARE | OTHER | 670335 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0786893000 | 01 | PA | INDEPENDENCE BLUE SHIELD | OTHER |