Healthcare Provider Details

I. General information

NPI: 1972020642
Provider Name (Legal Business Name): PHILADELPHIA HAND SURGEON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 W BALTIMORE PIKE STE 3415
MEDIA PA
19063-5104
US

IV. Provider business mailing address

1068 W BALTIMORE PIKE STE 3415
MEDIA PA
19063-5104
US

V. Phone/Fax

Practice location:
  • Phone: 484-444-2243
  • Fax: 484-444-8939
Mailing address:
  • Phone: 484-444-2243
  • Fax: 484-444-8939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIA MAYBERRY
Title or Position: MD/OWNER
Credential: MD
Phone: 484-444-2243