MEDICARE: CHILDREN'S HOSPITAL OF PHILADELPHIA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133V00000X	Registered Dietitian
2	133VN1004X	Pediatric Nutrition Registered Dietitian
3	133N00000X	Nutritionist

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	:	1902403694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S HOSPITAL OF PHILADELPHIA

Provider Business Mailing Address
First Line	:	3401 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 E BALTIMORE PIKE. SUITE A
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-1929
Country	:	US
Telephone Number	:	610-444-0113
Fax Number	:	610-444-0744

Authorized Official
Title or Position	:	CRS
Name	:	GALENA MOWDAY
Credential	:
Telephone Number	:	215-590-2897

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	02/10/2023

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Directions to “CHILDREN'S HOSPITAL OF PHILADELPHIA ” Practice Location

Language	Start Address	Practice Location

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