Healthcare Provider Details

I. General information

NPI: 1700478849
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S GODDARD BLVD
KING OF PRUSSIA PA
19406-2922
US

IV. Provider business mailing address

100 EAST PENN SQUARE WANAMAKER BUILDING. 6TH FLOOR
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 610-337-3232
  • Fax:
Mailing address:
  • Phone: 215-590-2897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

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