Healthcare Provider Details

I. General information

NPI: 1326809542
Provider Name (Legal Business Name): FAITH SONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 CHESTNUT ST
PHILADELPHIA PA
19104-2816
US

IV. Provider business mailing address

3141 CHESTNUT ST
PHILADELPHIA PA
19104-2816
US

V. Phone/Fax

Practice location:
  • Phone: 215-895-2000
  • Fax:
Mailing address:
  • Phone: 512-661-8213
  • 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: