Healthcare Provider Details

I. General information

NPI: 1487030763
Provider Name (Legal Business Name): JEFFERSON UNIVERSITY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD
NEWARK DE
19713-2072
US

IV. Provider business mailing address

4735 OGLETOWN STANTON RD
NEWARK DE
19713-2072
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8900
  • Fax: 215-923-3447
Mailing address:
  • Phone: 215-955-8900
  • Fax: 215-923-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateDE

VIII. Authorized Official

Name: WILLIAM BEHM
Title or Position: ASSOC. VP, HEALTH PLAN SERVICES
Credential:
Phone: 215-955-8236