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General NPI Number Information
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NPI Number | 1932140266
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Entity Type | Individual
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Provider Name | ROBERT EMREY BOOTH JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 02/22/2013
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Provider Practice Location Address
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Address Line | 601 WALNUT ST STE L50
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3323
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Country | US
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Telephone | 215-409-9300
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Fax | 215-409-9365
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Provider Business Mailing Address
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Address Line | PO BOX 8500-1672
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City | PHILADELPHIA
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State | PA
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Zip | 19106
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Country | US
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Telephone | 215-269-6700
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Fax | 215-269-6701
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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 | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | MD035352L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 25MA03361200
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License Number State | NJ
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