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General NPI Number Information
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NPI Number | 1326188970
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA VA MEDICA CENTER
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | PADRECC , PHILADELPHIA VA MEDICAL CENTER UNIVERSITY AND WOODLAND AVENUE
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 215-823-5800
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Fax | 215-823-4603
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Provider Business Mailing Address
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Address Line | 4816 PINE ST APT B202
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1721
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Country | US
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Telephone | 215-748-1346
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Fax |
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Authorized Official
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Title or Position | FELLOW
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Name | DR. ADRIAN T CHAN
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Credential | M.D.
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Telephone | 215-823-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 086131
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License Number State | OH
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