| Fcg Llc | |
|
1403 Rhawn Street Philadelphia PA 19111-2430 | |
| (215) 728-6688 | |
| (215) 342-1337 |
| Full Name | Fcg Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1403 Rhawn Street, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Mark Codella (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2157286688 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fcg Llc 1403 Rhawn Street Philadelphia PA 19111-2430 Ph: (215) 728-6688 | Fcg Llc 1403 Rhawn Street Philadelphia PA 19111-2430 Ph: (215) 728-6688 |
| NPI Number | 1245253533 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 02/06/2008 |
| Medicare PECOS PAC ID | 7618972027 |
|---|---|
| Medicare Enrollment ID | O20060918000478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245253533 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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