Healthcare Provider Details

I. General information

NPI: 1205662442
Provider Name (Legal Business Name): MADISON C HURLBURT PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 11/03/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ARCH ST
PHILADELPHIA PA
19106-1548
US

IV. Provider business mailing address

1008 N 5TH ST UNIT D
PHILADELPHIA PA
19123-1452
US

V. Phone/Fax

Practice location:
  • Phone: 215-521-4000
  • Fax:
Mailing address:
  • Phone: 443-910-7344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: