Healthcare Provider Details

I. General information

NPI: 1538279732
Provider Name (Legal Business Name): DREXEL UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 VINE ST 2ND FLOOR
PHILADELPHIA PA
19102-1031
US

IV. Provider business mailing address

1601 CHERRY ST SUITE 11511
PHILADELPHIA PA
19102-1321
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-2530
  • Fax: 215-762-2531
Mailing address:
  • Phone: 215-255-7751
  • Fax: 215-255-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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