Healthcare Provider Details

I. General information

NPI: 1942319777
Provider Name (Legal Business Name): CLINICAL CARE ASSOCIATES OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W WASHINGTON SQ 5TH FLOOR
PHILADELPHIA PA
19106-3500
US

IV. Provider business mailing address

3624 MARKET ST SUITE 560W
PHILADELPHIA PA
19104-2614
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-3668
  • Fax: 215-829-5002
Mailing address:
  • Phone: 215-662-2286
  • Fax: 866-586-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD BARG
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 610-239-2871