Healthcare Provider Details

I. General information

NPI: 1871067116
Provider Name (Legal Business Name): TEMPLE FACULTY PRACTICE PLAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3008
  • Fax: 215-707-1387
Mailing address:
  • Phone: 215-707-3008
  • Fax: 215-707-1387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET FERRARIE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 215-707-2433