Healthcare Provider Details

I. General information

NPI: 1699211854
Provider Name (Legal Business Name): PUBLIC HEALTH MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST FIRST FLOOR SUITE D101
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

3401 N BROAD ST FIRST FLOOR SUITE D101
PHILADELPHIA PA
19140-5103
US

V. Phone/Fax

Practice location:
  • Phone: 215-985-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY PRITCHARD
Title or Position: ADMIN/CREDENTIALING COORDINATOR
Credential:
Phone: 215-985-2595