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General NPI Number Information
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NPI Number | 1386646891
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Entity Type | Organization
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Legal Business Name | TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 8TH AT RACE STREET SECOND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-0000
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Country | US
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Telephone | 215-625-5381
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Fax | 215-629-4904
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Provider Business Mailing Address
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Address Line | PO BOX 827282
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City | PHILADELPHIA
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State | PA
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Zip | 19182-7282
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Country | US
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Telephone | 215-625-5341
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Fax | 215-629-0716
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LARRY MARK NEWMAN
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Credential | D.P.M
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Telephone | 215-625-5310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 15661501
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License Number State | PA
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