Healthcare Provider Details

I. General information

NPI: 1356458772
Provider Name (Legal Business Name): DREXEL UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 MARKET ST STE 105B
PHILADELPHIA PA
19104-3315
US

IV. Provider business mailing address

1601 CHERRY ST STE 11511
PHILADELPHIA PA
19102-1310
US

V. Phone/Fax

Practice location:
  • Phone: 215-220-4700
  • Fax:
Mailing address:
  • Phone: 215-255-7751
  • Fax: 215-255-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: EDWARD WALDOV
Title or Position: DIRECTOR OF REVENUE CYCLE - FINANCE
Credential:
Phone: 215-255-7751