Healthcare Provider Details

I. General information

NPI: 1932281094
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MARKET STREET 4TH FLOOR
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

301 LINDENWOOD DRIVE SUITE 350
MALVERN PA
19355
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3537
  • Fax: 215-590-1493
Mailing address:
  • Phone: 215-590-2897
  • Fax: 215-590-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: THOMAS TODOROW
Title or Position: VP FINANCE
Credential:
Phone: 267-426-6940