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General NPI Number Information
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NPI Number | 1659360519
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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 | 10/13/2005
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 3509 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-4105
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Country | US
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Telephone | 215-707-3663
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Fax | 215-707-6417
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Provider Business Mailing Address
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Address Line | 2450 W HUNTING PARK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1302
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Country | US
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Telephone | 215-707-3663
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Fax | 215-707-6417
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Authorized Official
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Title or Position | CREDENTIALING/MANAGER
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Name | TONYA WOODARD
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Credential |
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Telephone | 215-707-3911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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