Maxwell Ambrosino, DO
Individual provider Active NPI Internal Medicine Physician · Philadelphia, PA
NPI 1265060164 · NPPES record last updated Mar 1, 2024
Key facts
- NPI
- 1265060164
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- OS022918 (PA)
- Practice address
- 800 Spruce St
Philadelphia, PA 19107-6192 - Phone
- (215) 829-5410
- NPI assigned
- Mar 28, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Philadelphia College of Osteopathic Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cardiovascular Associates of the Delaware Valley,P a
Practice addresses (Care Compare)
210 W Atlantic Ave
Haddon Heights, NJ 08035-1715
Phone (856) 546-3003
Hospital & facility affiliations
- Deborah Heart and Lung Center
- Jefferson Stratford Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA, NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230727001603 | PA | Practitioner - Internal Medicine | 8820459506 | Reassigns benefits to 1 organization |
| I20250325001589 | NJ | Practitioner - Internal Medicine | 8820459506 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS022918 | PA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinical Care Associates of the University of Pennsylvania Health Syst | Current |
Accepting new patients | |
| Clinical Care Associates of the University of Pennsylvania Health | Current |
Accepting new patients | |
| Cardiovascular Associates of the Delaware Valley,P a | Current |
Accepting new patients | |
| Clinical Care Associates of the University of Pennsylvania Health | Internal Medicine | Current | Accepting new patients |
Locations
120 White Horse Pike
Ste 112
Haddon Hgts, NJ 08035
Phone 85654705392215
210 W Atlantic Ave
Haddon Hts, NJ 08035
Phone (856) 546-3003
800 Spruce St
Fl 1
Philadelphia, PA 19107
Phone (215) 829-5873
800 Spruce St
William Penn Annex West, PA 19107
Phone (215) 829-3867
800 Spruce St
#1
William Penn Annex West, PA 19107
Phone (215) 829-2222
777 Township Line Rd
Ste 200
Yardley, PA 19067
Phone (215) 860-0775
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | OS022918 | PA | Yes |
Addresses
Primary practice location
800 Spruce St
Philadelphia, PA 19107-6192
Mailing address
800 Spruce St
1 Pine West
Philadelphia, PA 19107-6130
Phone (215) 829-5410
Other providers in Philadelphia, PA
- Riley Elizabeth Ambrose
- Timothy Michael Ambrose
- Aarthi Kamala Ambrosi
- Amy Lynn Ambrosini
- Paul Ambrosini
- Michele Ann Ambrosino
- Ambulance Express Inc
- Ambulance Express Inc
- Ambulance of America Inc
- Ambulance Services of America, Inc
All providers in Philadelphia, PA · Internal Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.