Healthcare Provider Details

I. General information

NPI: 1063308096
Provider Name (Legal Business Name): CHRISTIANA CARE HAVERTOWN ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 W CHESTER PIKE STE 212
HAVERTOWN PA
19083-2736
US

IV. Provider business mailing address

2010 W CHESTER PIKE STE 212
HAVERTOWN PA
19083-2736
US

V. Phone/Fax

Practice location:
  • Phone: 610-853-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DOUGLAS AZAR
Title or Position: DIRECTOR/OFFICER
Credential:
Phone: 484-678-8475