Healthcare Provider Details

I. General information

NPI: 1275832826
Provider Name (Legal Business Name): SARAH EMILY HENRICKSON M.D. PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD 3550 MARKET STREET, 3RD FLOOR
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD DIVISION OF ALLERGY IMMUNOLOGY
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-2549
  • Fax: 215-590-4259
Mailing address:
  • Phone: 215-590-2549
  • Fax: 215-590-4259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT204850
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberMT204850
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: