Healthcare Provider Details

I. General information

NPI: 1841059516
Provider Name (Legal Business Name): JEFFERSON UNIVERSITY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 S 9TH ST
PHILADELPHIA PA
19107-4414
US

IV. Provider business mailing address

1101 MARKET ST FL 19
PHILADELPHIA PA
19107-2926
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-1175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN PADGETT
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 215-955-1175