Healthcare Provider Details

I. General information

NPI: 1013904945
Provider Name (Legal Business Name): TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SPROUL RD MARPLE COMMONS
BROOMALL PA
19008-3509
US

IV. Provider business mailing address

3425 N CARLISLE ST 2ND FL HUDSON BUILDING
PHILADELPHIA PA
19140-5108
US

V. Phone/Fax

Practice location:
  • Phone: 610-353-1936
  • Fax:
Mailing address:
  • Phone: 215-707-4739
  • Fax: 215-707-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS G KUPP
Title or Position: CFO
Credential:
Phone: 215-707-7551