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General NPI Number Information
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NPI Number | 1679953798
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEALTHCARE DYNAMICS
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 1313 WOLF ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-2911
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Country | US
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Telephone | 215-465-3000
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Fax | 215-465-1085
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Provider Business Mailing Address
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Address Line | 1313 WOLF ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-2911
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Country | US
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Telephone | 215-465-3000
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Fax | 215-465-1085
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RICHARD J DITTRICH
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Credential | D.O.
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Telephone | 215-465-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | OS003098L
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License Number State | PA
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