39D0981836 CLIA NUMBER - PHA ADULT MEDICINE

Laboratory Demographics

CLIA Number: 39D0981836

Facility Name: PHA ADULT MEDICINE

Facility Address:
1740 SOUTH STREET SUITE 300
PHILADELPHIA, PA
ZIP 19146
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Facility Phone Number: 215 732-0876

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1598925885

Taxonomy: 207RG0100X - Internal Medicine
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.

CLIA Record

Field Name	Field Value
CLIA Number	39D0981836
LAB Type	Physician Office
Facility Name	PHA ADULT MEDICINE
Street	1740 SOUTH STREET SUITE 300
City	PHILADELPHIA
State	PA
ZIP	19146
Phone	215 732-0876
CertificateType	4
CertificateEffectiveDate	1/9/2023
CertificateExpirationDate	1/8/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024