Healthcare Provider Details

I. General information

NPI: 1073603536
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 FOULK ROAD SUITE 101
WILMINGTON DE
19803
US

IV. Provider business mailing address

301 LINDENWOOD DRIVE SUITE 350
MALVERN PA
19355
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-3242
  • Fax: 302-655-5392
Mailing address:
  • Phone: 215-590-2897
  • Fax: 215-590-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateDE

VIII. Authorized Official

Name: THOMAS TODOROW
Title or Position: VP FINANCE
Credential:
Phone: 267-426-6940