Healthcare Provider Details

I. General information

NPI: 1124234810
Provider Name (Legal Business Name): TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 N BROAD ST
PHILADELPHIA PA
19140-4105
US

IV. Provider business mailing address

3425 N CARLISLE ST 2ND FL HUDSON BUILDING
PHILADELPHIA PA
19140-5108
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-6068
  • Fax: 215-707-6085
Mailing address:
  • Phone: 215-707-3911
  • Fax: 215-707-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS KUPP
Title or Position: CFO
Credential:
Phone: 215-707-4739