MEDICARE: DR. ISSY CLAIRE ESANGBEDO M.D.

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	208000000X	Pediatrics Physician	MD427489	PA

General Provider Information

NPI Number	:	1871606939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISSY CLAIRE ESANGBEDO M.D.

Provider Business Mailing Address
First Line	:	100 E PENN SQ
Second Line	:	9TH FLOOR NORTH TOWER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-3323
Country	:	US
Telephone Number	:	267-425-9234
Fax Number	:	267-425-9299

Provider Business Practice Location Address
First Line	:	3550 MARKET ST
Second Line	:	CHOP CARE NETWORK @ MARKET STREET SPECIALTY CARE CENTER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3329
Country	:	US
Telephone Number	:	215-590-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	01/13/2014

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