MEDICARE: DREXEL HILL PEDIATRIC ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477680874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREXEL HILL PEDIATRIC ASSOCIATES

Provider Business Mailing Address
First Line	:	400 S STATE RD STE 210
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-1243
Country	:	US
Telephone Number	:	610-623-9080
Fax Number	:	610-623-3861

Provider Business Practice Location Address
First Line	:	400 S STATE RD STE 210
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-1243
Country	:	US
Telephone Number	:	610-623-9080
Fax Number	:	610-623-3861

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. MATTHEW BRANDON MCCARTHY
Credential	:	MD
Telephone Number	:	610-623-9080

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	10/19/2021

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