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General NPI Number Information
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NPI Number | 1811945538
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Entity Type | Organization
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Legal Business Name | ST. CHRISTOPHER'S PEDIATRIC ASSOCIATES
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | FRONT STREET AT ERIE AVE. SUITE 2205
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City | PHILADELPHIA
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State | PA
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Zip | 19134
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Country | US
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Telephone | 215-427-8915
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Fax | 215-427-4603
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Provider Business Mailing Address
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Address Line | FRONT STREET AT ERIE AVENUE SUITE 2205
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City | PHILADELPHIA
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State | PA
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Zip | 19134
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Country | US
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Telephone | 215-427-8915
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Fax | 215-427-4603
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | TRACEY PAGE
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Credential |
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Telephone | 215-427-3725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD021329E
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License Number State | PA
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