Healthcare Provider Details

I. General information

NPI: 1245283324
Provider Name (Legal Business Name): EVE JULIET HIGGINBOTHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVE JULIET HIGGINBOTHAM-WILLIAMS MD

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD WEST PAVILION, 3RD FLOOR
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD WEST PAVILION, 3RD FLOOR
PHILADELPHIA PA
19104-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-614-4100
  • Fax:
Mailing address:
  • Phone: 215-614-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD450649
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD450649
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: