Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Dec 2, 2020
License(s)
MD430585 (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2200 ARCH ST UNIT 204 | Philadelphia, PA 19103-1348 | 215-850-8589 |
| MAILING | 2200 ARCH ST UNIT 204 | Philadelphia, PA 19103-1348 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.