Healthcare Provider Details

I. General information

NPI: 1659339232
Provider Name (Legal Business Name): COREY KADES RUTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MARKET STREET 24TH FLOOR-WEST TOWER
PHILADELPHIA PA
19102
US

IV. Provider business mailing address

227 N BROAD ST SUITE 300
PHILADELPHIA PA
19107-1511
US

V. Phone/Fax

Practice location:
  • Phone: 215-255-3828
  • Fax: 215-255-3577
Mailing address:
  • Phone: 215-988-0611
  • Fax: 215-988-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMD027112E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: