NPIMap

Organization Active NPI

Fairmount Pediatrics and Adolescent Medicine

  • Primary Care Clinic/Center
  • Phila, PA
National Provider Identifier
1487987020
Registry record updated Sep 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
MD059659L Issued in PA
Legal business name
FAIRMOUNT PEDIATRICS AND ADOLESCENT MEDICINE
Practice address
2000 Hamilton St
#109
Phila, PA 19130-3814
Phone
(215) 774-1166
Fax
(215) 279-8383
NPI assigned
Sep 15, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Alexis S Lieberman, M.D.
Title
Member Manager
Phone
(215) 774-1166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X MD059659L PA Primary

Addresses

Primary practice location

2000 Hamilton St
#109
Phila, PA 19130-3814

Mailing address

7042 Greene St
Phila, PA 19119-3439
Phone (215) 990-6625

National Provider Directory

National Provider Directory

Locations

2000 Hamilton St
Frnt 1
Philadelphia, PA 19130

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252972800000",
    "number": "1487987020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7042 GREENE ST",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191193439",
            "telephone_number": "215-990-6625",
            "fax_number": "215-279-8383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 HAMILTON ST",
            "address_2": "#109",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191303814",
            "telephone_number": "215-774-1166",
            "fax_number": "215-279-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRMOUNT PEDIATRICS AND ADOLESCENT MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-15",
        "last_updated": "2009-09-15",
        "status": "A",
        "authorized_official_last_name": "LIEBERMAN",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "215-774-1166",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "PA",
            "license": "MD059659L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phila, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.