Provider Demographics
NPI:1043292816
Name:STRONG, MORTIMER JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:MORTIMER
Middle Name:JAMES
Last Name:STRONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:709 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3043
Mailing Address - Country:US
Mailing Address - Phone:215-925-6633
Mailing Address - Fax:215-925-7428
Practice Address - Street 1:201 OLD YORK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3200
Practice Address - Country:US
Practice Address - Phone:215-885-6767
Practice Address - Fax:215-885-5297
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS004367-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000850614Medicaid
PA0000850614Medicaid
PA0000130849Medicare ID - Type Unspecified