| NPI | LastName | FirstName | MidName | Organization | Mailing Address | City | State | Zip |
| 1003292293 | HARRISON | DIANA | PAOLA | 1412 22 FAIRMOUNT AVENUE | PHILADELPHIA | PA | 191302908 | |
| 1477761716 | LAWRENCE | DONALD | R | 1412 FAIRMOUNT AVE | PHILADELPHIA | PA | 191302908 | |
| 1891112496 | MACZUGA | BRENT | P | 1412-22 FAIRMOUNT AVENUE | PHILADELPHIA | PA | 19130 | |
| 1518577188 | RIVERA JONES | ALICIA | M | 1412 FAIRMOUNT AVE | PHILADELPHIA | PA | 191302908 | |
| 1801270459 | STROUT | ANNIE | 1412 FAIRMOUNT AVE | PHILADELPHIA | PA | 191302908 | ||
| 1427453240 | TOBIAS | CHRISTOPHER | THOMAS | 1412-12 FAIRMOUNT AVE | PHILADELPHIA | PA | 191302908 |