Healthcare Provider Details

I. General information

NPI: 1952550519
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH AND CIVIC CENTER BLVD ONE CHILDREN'S CENTER, DIV OF PEDIATRIC CARDIOLOGY
PHILADELPHIA PA
19104-4399
US

IV. Provider business mailing address

37 S 20TH ST APT 4C
PHILADELPHIA PA
19103-3526
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-5438
  • Fax:
Mailing address:
  • Phone: 734-717-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberMT189793
License Number StatePA

VIII. Authorized Official

Name: DR. PETER FEKRI AZIZ
Title or Position: PEDIATRIC CARDIOLOGY FELLOW
Credential: M.D.
Phone: 215-590-3548