Healthcare Provider Details

I. General information

NPI: 1154393205
Provider Name (Legal Business Name): KAREN HOUCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST 7TH FLOOR OUT PATIENT BUILDING
PHILADELPHIA PA
19140
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 Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD073779L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: