Healthcare Provider Details

I. General information

NPI: 1255644175
Provider Name (Legal Business Name): THOMAS JEFFERSON UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S 9TH ST
PHILADELPHIA PA
19107-4408
US

IV. Provider business mailing address

25 S 9TH ST
PHILADELPHIA PA
19107-4408
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA MARIE GUANCHE
Title or Position: RESIDENT
Credential: M.D.
Phone: 305-333-0412