Healthcare Provider Details

I. General information

NPI: 1770550089
Provider Name (Legal Business Name): TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 N BROAD ST TEMPLE UNIVERSITY CHILDRENS MEDICAL CENTER
PHILADELPHIA PA
19140
US

IV. Provider business mailing address

PO BOX 820890 TEMPLE PEDIATRIC EMERGENCY MEDICAL ASSOCIATES
PHILADELPHIA PA
19182-0890
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-6606
  • Fax: 215-707-6629
Mailing address:
  • Phone: 800-666-2455
  • Fax: 610-617-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT GREGORY FLOOD
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 215-707-6606