DR. WALTER E BANTOM III (NPI# 1194741710) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194741710 |
| Entity Type | Individual |
| Full Name | DR. WALTER E BANTOM III |
| Credential | M.D. |
| Practice Address |
5615 W Girard Ave Philadelphia PA 19131-4128 |
| Practice Telephone | 2154775800 |
| Practice Fax Number | 2158798447 |
| Mailing Telephone | 2154775800 |
| Mailing Fax Number | 2158798447 |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2013-04-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MD04394E | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | MEDICARE ID - TYPE UNSPECIFIED | 218045 | 01 |
| PA | 1172977 | 05 | |
| PA | INDEPENDENCE BLUE CROSS | 0110990001 | 01 |
| Street Address |
5615 W GIRARD AVE |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19131-4128 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538437983 | Melissa J. Tucker | Nurse Practitioner | 5615 W Girard Ave, Philadelphia, PA 19131-4128 | 2011-12-13 |
| 1598785115 | Daniel A Jones | Internal Medicine | 5615 W Girard Ave, Philadelphia, PA 19131-4128 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629678925 | Jonathan Welch | Student in an Organized Health Care Education/Training Program | 4200 E City Ave, Rowland Hall, Suite 207, Physician Assistant Department, Philadelphia, PA 19131 | 2020-10-27 |
| 1659970689 | Novacare Outpatient Rehabilitation East, Inc. | Clinic/Center | 1575 North 25nd Street, Philadelphia, PA 19131 | 2020-10-21 |
| 1821629254 | Stephen Osowski | Student in an Organized Health Care Education/Training Program | 4170 City Avenue, Philadelphia, PA 19131 | 2020-02-04 |
| 1134774888 | Arti D Mistry | Dentist | 1126 Horsham Road, Philadelphia, PW 19131 | 2019-08-08 |
| 1275187221 | Grace Bernadette Farrelly | Occupational Therapist | 2101 Simpson House, Philadelphia, PA 19131 | 2019-07-29 |
| 1235795204 | Isd Renal Inc | Clinic/Center | 4952 Parkside Ave, Philadelphia, PA 19131 | 2019-05-15 |
| 1922502582 | Kevin David Wojcik | Student in an Organized Health Care Education/Training Program | Philadelphia College of Osteopathic Medicine, 4190 City Ave, Philadelphia, PA 19131 | 2018-03-20 |
| 1235633900 | Nadja Hill | Home Health | 5203 Diamond Street, Philadelphia, PA 19131 | 2018-03-19 |
| 1932623857 | Mercy Management of Sepa | Social Worker | 1575 N 52nd St Ste 800, Philadelphia, PA 19131 | 2017-08-02 |
| 1578092235 | Sarah Marie Hoder | Specialist/Technologist | 4000 Presidential Avenue, Philadlephia, PA 19131 | 2017-06-07 |
| Find all providers in zip 19131 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427674407 | Jun Song | Internal Medicine | 3401 N Broad St Ste 801, Philadelphia, PA 19140-5103 | 2020-06-24 |
| 1932725264 | Aaron Leo Yazdian | Internal Medicine | 1335 South St Apt A, Philadelphia, PA 19147-1841 | 2020-06-23 |
| 1144846387 | Rishabh Khatri | Internal Medicine | 322 N Broad St Apt 1523, Philadelphia, PA 19102-1122 | 2020-06-23 |
| 1215564521 | Insight Home Physicians, PC | Internal Medicine | 7806 Cresheim Rd, Philadelphia, PA 19118-4003 | 2020-03-25 |
| 1457995938 | Tower Drexel Academic Medical Group LLC | Internal Medicine | 3401 Market St Ste 105b, Philadelphia, PA 19104-3315 | 2019-10-29 |
| 1205479904 | Tower Drexel Academic Medical Group LLC | Internal Medicine | 219 N Broad St 8fl, Philadelphia, PA 19107-1507 | 2019-10-25 |
| 1700439056 | Alvaro Goncalves Mendes Neto | Internal Medicine | 5501 Old York Rd # 363, Philadelphia, PA 19141-3018 | 2019-07-16 |
| 1720648223 | Ali Haydar | Internal Medicine | 245 N. 15th St, 6th Floor, Ms 42, Philadelphia, PA 19102 | 2019-06-17 |
| 1114587672 | Stephen Michael Pokrywa | Internal Medicine | Drexel University Com, Internal Medicine Residency, 245 N. 15th St., 6th Floor, Ms 427, Philadelphia, PA 19102-1178 | 2019-06-17 |
| 1124688734 | Aakash Patel | Internal Medicine | Drexel University College of Medicine-internal Medicine, 245 N. 15th St. 6th Floor, Ms 427, Philadelphia, PA 19102 | 2019-06-17 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19131 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.