Healthcare Provider Details

I. General information

NPI: 1649596933
Provider Name (Legal Business Name): DEREK THOMAS WARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PARNASSUS AVE # MU320
SAN FRANCISCO CA
94143-2203
US

IV. Provider business mailing address

833 CHESTNUT ST 1402
PHILADELPHIA PA
19107-4404
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-6043
  • Fax:
Mailing address:
  • Phone: 800-321-9999
  • Fax: 267-339-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD454724
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA09697700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: