Provider Demographics
NPI:1679626642
Name:BUCKS PHILADELPHIA MEDICAL CARE GROUP
Entity type:Organization
Organization Name:BUCKS PHILADELPHIA MEDICAL CARE GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-947-6143
Mailing Address - Street 1:725 LISA CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2223
Mailing Address - Country:US
Mailing Address - Phone:215-947-6143
Mailing Address - Fax:215-947-6274
Practice Address - Street 1:1718 WELSH ROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3100
Practice Address - Country:US
Practice Address - Phone:215-947-6143
Practice Address - Fax:215-947-6274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036462E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011212100001Medicaid
PA0486513000OtherPERSONAL CHOICE
PA0486513001OtherBLUE SHLD,HIGHMRK,KEYSTON
PAB37348Medicare UPIN
PA0486513000OtherPERSONAL CHOICE