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General NPI Number Information
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NPI Number | 1477808459
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Entity Type | Organization
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Legal Business Name | THE PENNSYLVANIA HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYS
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 230 W WASHINGTON SQ FARM JOURNAL BUILDING, 4TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3500
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Country | US
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Telephone | 215-829-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 230 W WASHINGTON SQ FARM JOURNAL BUILDING, 4TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3500
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Country | US
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Telephone | 215-829-3561
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Fax |
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Authorized Official
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Title or Position | AVP
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Name | THOMAS MCCORMICK SR.
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Credential |
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Telephone | 215-762-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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