Healthcare Provider Details

I. General information

NPI: 1487342846
Provider Name (Legal Business Name): PHMC DELCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

IV. Provider business mailing address

1500 MARKET ST FL 16
PHILADELPHIA PA
19102-2100
US

V. Phone/Fax

Practice location:
  • Phone: 215-984-6244
  • Fax:
Mailing address:
  • Phone: 215-985-6244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. RAJAN VISWANATHAN
Title or Position: SENIOR DIRECTOR OF QAPI
Credential: MBA
Phone: 215-370-8529