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General NPI Number Information
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NPI Number | 1285652255
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Entity Type | Organization
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Legal Business Name | WOODWARD INTERNAL MEDICINE, INC.
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 2375 WOODWARD ST SUITE 115
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City | PHILADELPHIA
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State | PA
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Zip | 19115-5120
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Country | US
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Telephone | 215-671-9003
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Fax | 215-671-9004
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Provider Business Mailing Address
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Address Line | 2375 WOODWARD ST SUITE 115
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City | PHILADELPHIA
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State | PA
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Zip | 19115-5120
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Country | US
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Telephone | 215-671-9003
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Fax | 215-671-9004
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Authorized Official
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Title or Position | OWNER
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Name | YELENA YACHMENYOVA
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Credential | MD
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Telephone | 215-671-9003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD061999L
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License Number State | PA
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