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General NPI Number Information
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NPI Number | 1851773782
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Entity Type | Individual
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Provider Name | GUANJUN XIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2015
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 245 N 15TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1101
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Country | US
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Telephone | 410-564-7484
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Fax |
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Provider Business Mailing Address
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Address Line | 23 EGRET LN
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City | MARLBORO
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State | NJ
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Zip | 07746-1074
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Country | US
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Telephone | 410-564-7484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD467000
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MT208849
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 25MA10869700
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License Number State | NJ
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