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General NPI Number Information
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NPI Number | 1942319777
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Entity Type | Organization
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Legal Business Name | CLINICAL CARE ASSOCIATES OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYST
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 230 W WASHINGTON SQ 5TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3500
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Country | US
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Telephone | 215-829-3668
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Fax | 215-829-5002
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Provider Business Mailing Address
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Address Line | 3624 MARKET ST SUITE 560W
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2614
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Country | US
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Telephone | 215-662-2286
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Fax | 866-586-2431
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RONALD BARG
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Credential | MD
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Telephone | 610-239-2871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State |
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