Healthcare Provider Details

I. General information

NPI: 1245706183
Provider Name (Legal Business Name): CHILDRENS HOSPITAL OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 W LANCASTER AVE
BRYN MAWR PA
19010-3805
US

IV. Provider business mailing address

663 W LANCASTER AVE
BRYN MAWR PA
19010-3805
US

V. Phone/Fax

Practice location:
  • Phone: 610-658-0999
  • Fax: 610-658-1998
Mailing address:
  • Phone: 610-658-0999
  • Fax: 610-658-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: THOMAS J TODOROW
Title or Position: CFO
Credential:
Phone: 267-426-6957