Healthcare Provider Details

I. General information

NPI: 1700293529
Provider Name (Legal Business Name): THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S COBBS CREEK PKWY
PHILADELPHIA PA
19139-3723
US

IV. Provider business mailing address

225 S COBBS CREEK PKWY
PHILADELPHIA PA
19139-3723
US

V. Phone/Fax

Practice location:
  • Phone: 215-476-2223
  • Fax: 215-476-3981
Mailing address:
  • Phone: 215-476-2223
  • Fax: 215-476-3981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ED BLEACHER
Title or Position: VP, CORPORATE FINANCE
Credential:
Phone: 267-426-6940