Provider Demographics
NPI:1043246663
Name:EDWARD J FILIPPONE MD PC
Entity type:Organization
Organization Name:EDWARD J FILIPPONE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FILIPPONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:215-467-8955
Mailing Address - Street 1:2228 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3923
Mailing Address - Country:US
Mailing Address - Phone:215-467-8955
Mailing Address - Fax:215-467-8956
Practice Address - Street 1:2228 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3923
Practice Address - Country:US
Practice Address - Phone:215-467-8955
Practice Address - Fax:215-467-8956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012805800003Medicaid
PA0012805800003Medicaid