Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Residentialist Housecall Med Grp, PC a Pennsylvania Corp

Organization Geriatric Medicine (Family Medicine) Physician · NPI 1104205400

Residentialist Housecall Med Grp, PC a Pennsylvania Corp is a Geriatric Medicine (Family Medicine) Physician in Philadelphia, Pennsylvania. Licensed in Pennsylvania. Registered with an NPI since 2015.

Licensed in
PA
In the registry since
2015
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.
Corp — Corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4190 City Ave Pcom - Rowland Hall Rm 528
Philadelphia, PA 19131-1626
Phone: (949) 366-1053
Fax: (949) 544-7880
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Geriatric Medicine (Family Medicine) Physician (primary) Taxonomy 207QG0300X · Licence OS017618 (PA)

Record details

NPI number1104205400
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Marie Walton — Billing Manager · (949) 366-1053
NPI enumeratedMay 20, 2015
Last updated in NPPESMarch 5, 2025
Certification dateMarch 5, 2025
Mailing address3800 Kilroy Airport Way Ste 270, Long Beach, CA 90806-2497

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