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General NPI Number Information
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NPI Number | 1861516528
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Entity Type | Organization
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Legal Business Name | PARKWOOD MEDICAL PRACTICE PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 12401 ACADEMY RD SUITE 203
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City | PHILADELPHIA
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State | PA
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Zip | 19154-1932
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Country | US
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Telephone | 215-637-3100
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Fax | 215-637-7310
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Provider Business Mailing Address
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Address Line | 12401 ACADEMY RD SUITE 203
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City | PHILADELPHIA
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State | PA
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Zip | 19154-1932
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Country | US
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Telephone | 215-637-3100
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Fax | 215-637-7310
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Authorized Official
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Title or Position | OWNER
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Name | HAL B GANZMAN
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Credential | D.O.
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Telephone | 215-637-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS007829L
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License Number State | PA
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