=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871606939
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISSY CLAIRE ESANGBEDO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 01/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3550 MARKET ST CHOP CARE NETWORK @ MARKET STREET SPECIALTY CARE CENTER
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19104-3329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-590-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 E PENN SQ 9TH FLOOR NORTH TOWER
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-3323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-425-9234
-----------------------------------------------------
Fax | 267-425-9299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD427489
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------