Healthcare Provider Details

I. General information

NPI: 1851096614
Provider Name (Legal Business Name): CHRISTINE PHILIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S BROAD ST APT 201
PHILADELPHIA PA
19145-2340
US

IV. Provider business mailing address

1700 S BROAD ST APT 201
PHILADELPHIA PA
19145-2340
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS025660
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: