Healthcare Provider Details

I. General information

NPI: 1124400536
Provider Name (Legal Business Name): ASHLIE LAUREN NADLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date: 01/29/2016
Reactivation Date: 02/17/2016

III. Provider practice location address

3509 N. BROAD ST. TEMPLE UNIVERSITY HOSPITAL GRADUATE MEDICAL EDUCATION
PHILADELPHIA PA
19140
US

IV. Provider business mailing address

333 COTTMAN AVENUE ROOM H3-133 FOX CHASE CANCER CENTER
PHILADELPHIA PA
19111
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-3016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD454628
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: