Healthcare Provider Details

I. General information

NPI: 1467494096
Provider Name (Legal Business Name): KARIN FLYNN-RODDEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 S BROAD ST
PHILADELPHIA PA
19148
US

IV. Provider business mailing address

1629 S BROAD ST
PHILADELPHIA PA
19148
US

V. Phone/Fax

Practice location:
  • Phone: 215-467-7318
  • Fax: 215-467-7318
Mailing address:
  • Phone: 215-467-7360
  • Fax: 215-467-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number25MA05399500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberMD037839E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: