Healthcare Provider Details

I. General information

NPI: 1710515085
Provider Name (Legal Business Name): CHRISTOPHER JON ESWORTHY II PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 WALNUT ST STE 950
PHILADELPHIA PA
19102-3628
US

IV. Provider business mailing address

200 N 16TH ST APT 1306
PHILADELPHIA PA
19102-1209
US

V. Phone/Fax

Practice location:
  • Phone: 267-273-1196
  • Fax:
Mailing address:
  • Phone: 607-725-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9113097
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062257
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: