Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Phillymedclub PLLC

Organization Family Medicine Physician · NPI 1912642703

Phillymedclub PLLC is a Family Medicine Physician in Philadelphia, Pennsylvania. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1300 N 2nd St Ofc 101
Philadelphia, PA 19122-4594
Phone: (215) 776-7308
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1912642703
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Wayne Raneiro — Cmo · (215) 776-7308
NPI enumeratedMay 5, 2022
Last updated in NPPESMay 5, 2022
Certification dateMay 5, 2022
Mailing address1300 N 2nd St Ofc 101, Philadelphia, PA 19122-4594

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