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General NPI Number Information
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NPI Number | 1053487496
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Entity Type | Individual
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Provider Name | EDITH D HASBROUCK MD
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 1200 W TABOR RD SUITE 141
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3019
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Country | US
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Telephone | 215-456-9142
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Fax | 215-456-9052
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Provider Business Mailing Address
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Address Line | 1200 TABOR ROAD SUITE 141 MOSS-CADD
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City | PHILADELPHIA
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State | PA
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Zip | 19150
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Country | US
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Telephone | 215-456-9142
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Fax | 215-456-9052
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MD031068E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD031068E
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License Number State | PA
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