Healthcare Provider Details

I. General information

NPI: 1841268604
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: 03/09/2006
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-7756
  • Fax: 215-707-5885
Mailing address:
  • Phone: 215-707-2912
  • Fax: 215-707-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELINA FAGAN
Title or Position: FINANCIAL SUPERVISOR / MANAGER
Credential:
Phone: 215-707-2828