Healthcare Provider Details

I. General information

NPI: 1063623544
Provider Name (Legal Business Name): CHRISTOPHER JOHN LAROSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CIVIC CENTER BLVD
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

100 PENN SQUARE EAST 9TH FLOOR NORTH TOWER
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax: 215-590-3992
Mailing address:
  • Phone: 267-425-9200
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD431123
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: