Basic Information
| Provider Information | |||||||||
| NPI: | 1942471024 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARIA HEALTH PHYSICIAN SERVICES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | JEFFERSON HEMATOLOGY MEDICAL ONCOLOGY ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 825395 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191825395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154816873 | ||||||||
| FaxNumber: | 2154813985 | ||||||||
| Practice Location | |||||||||
| Address1: | 10800 KNIGHTS RD FL 3 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191144200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158903030 | ||||||||
| FaxNumber: | 2158903031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2008 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | KUMOR | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2156124823 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1007526250039 | 05 | PA | MEDICAID | 30022701 | 01 | PA | KEYTSTONE MERCY | OTHER | 1007526250041 | 05 | PA | MEDICAID | 1007526250051 | 05 | PA | MEDICAID | 35488 | 01 | PA | HEALTH PARTNERS | OTHER |