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General NPI Number Information
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NPI Number | 1174588727
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA UROSURGICAL ASSOCIATES PC
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 207 N BROAD ST 4TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1500
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Country | US
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Telephone | 215-863-8100
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Fax | 215-587-6252
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Provider Business Mailing Address
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Address Line | 207 N BROAD ST 4TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1500
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Country | US
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Telephone | 215-863-8100
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Fax | 215-587-6252
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Authorized Official
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Title or Position | OFFICER/DIRECTOR
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Name | DR. KRISTENE E. WHITMORE
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Credential | M.D.
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Telephone | 215-863-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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