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General NPI Number Information
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NPI Number | 1033693718
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Entity Type | Organization
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Legal Business Name | REVOLUTION PS, P.C.
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 1601 WALNUT ST STE 208
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2902
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Country | US
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Telephone | 215-372-5000
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Fax | 215-372-6000
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Provider Business Mailing Address
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Address Line | 1601 WALNUT ST STE 208
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2902
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Country | US
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Telephone | 215-372-5000
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Fax | 215-372-6000
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Authorized Official
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Title or Position | OWNER
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Name | DAVID ANTHONY EHRLICH
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Credential | MD
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Telephone | 215-372-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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