Healthcare Provider Details

I. General information

NPI: 1639707995
Provider Name (Legal Business Name): HANNAH NELKIN FACEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CRESCENT DR FL 2
PHILADELPHIA PA
19112-1016
US

IV. Provider business mailing address

3 CRESCENT DR FL 2
PHILADELPHIA PA
19112-1016
US

V. Phone/Fax

Practice location:
  • Phone: 215-551-8660
  • Fax: 215-551-9247
Mailing address:
  • Phone: 215-551-8660
  • Fax: 215-551-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD480421
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: