Healthcare Provider Details

I. General information

NPI: 1932702529
Provider Name (Legal Business Name): ADVOCARE , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 WALNUT ST STE 950
PHILADELPHIA PA
19102-3628
US

IV. Provider business mailing address

1528 WALNUT ST STE 950
PHILADELPHIA PA
19102-3628
US

V. Phone/Fax

Practice location:
  • Phone: 267-273-1196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES MCQUEARY
Title or Position: AO
Credential:
Phone: 856-872-7052