Healthcare Provider Details

I. General information

NPI: 1982921193
Provider Name (Legal Business Name): JEFFERSON UNIVERSITY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CHESTNUT ST SUITE 320A
PHILADELPHIA PA
19107-4216
US

IV. Provider business mailing address

925 CHESTNUT ST SUITE 320A
PHILADELPHIA PA
19107-4216
US

V. Phone/Fax

Practice location:
  • Phone: 215-503-7675
  • Fax:
Mailing address:
  • Phone: 215-503-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License NumberSP010699
License Number StatePA

VIII. Authorized Official

Name: REBECCA MARLOW
Title or Position: NURSE MANAGER
Credential:
Phone: 215-955-8874