Healthcare Provider Details

I. General information

NPI: 1316616717
Provider Name (Legal Business Name): DREXEL UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 VINE ST FL 2
PHILADELPHIA PA
19102-1031
US

IV. Provider business mailing address

1427 VINE ST FL 2
PHILADELPHIA PA
19102-1031
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-2530
  • Fax: 215-762-2531
Mailing address:
  • Phone: 215-762-2530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: EDWARD E WALDOV
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 215-255-7751