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General NPI Number Information
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NPI Number | 1215097803
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Entity Type | Organization
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Legal Business Name | THOMAS JEFFERSON UNIVERSITY HOSPITAL
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 S 11TH ST SUITE 4240 GIBBON BLDG.
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4824
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Country | US
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Telephone | 215-955-8874
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Fax | 215-955-2349
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Provider Business Mailing Address
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Address Line | 125 S 9TH ST SUITE 801 SHERIDAN BLDG.
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5125
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Country | US
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Telephone | 215-955-8963
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Fax | 215-955-9641
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Authorized Official
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Title or Position | DIRECTOR, RESEARCH ADMINISTRATION
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Name | SUSAN BEAL
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Credential |
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Telephone | 215-503-1295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD026819E
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License Number State | PA
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