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General NPI Number Information
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NPI Number | 1386288702
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Entity Type | Organization
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Legal Business Name | ADVOCARE , LLC
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 2000 HAMILTON ST STE 109
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3847
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Country | US
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Telephone | 215-774-1166
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 71422
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City | PHILADELPHIA
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State | PA
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Zip | 19176-1422
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Country | US
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Telephone | 856-872-7055
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Fax | 856-504-8029
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Authorized Official
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Title or Position | EXECUTIVE VP AND COO
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Name | CHARLES MCQUEARY
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Credential |
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Telephone | 856-872-7052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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