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General NPI Number Information
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NPI Number | 1770617441
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Entity Type | Organization
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Legal Business Name | TEMPLE UNIVERSITY OPHTHALMOLOGY
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 3401 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5103
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Country | US
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Telephone | 215-707-4998
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Fax |
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Provider Business Mailing Address
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Address Line | 130 E HARTWELL LN
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City | PHILADELPHIA
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State | PA
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Zip | 19118-3431
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Country | US
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Telephone | 215-381-0546
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Fax |
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Authorized Official
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Title or Position | RESIDENT
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Name | DR. DOROTHY HELEN HENDRICKS
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Credential | M.D.
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Telephone | 215-707-4998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MT184750
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License Number State | PA
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