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General NPI Number Information
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NPI Number | 1992744197
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Entity Type | Individual
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Provider Name | GERALD R PHELAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 39 E CHESTNUT HILL AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19118-2728
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Country | US
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Telephone | 215-248-5600
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Fax | 215-242-0160
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Provider Business Mailing Address
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Address Line | 6005 CRICKET RD
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City | FLOURTOWN
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State | PA
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Zip | 19031-1202
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Country | US
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Telephone | 215-248-5600
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Fax | 215-242-0160
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD018700E
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License Number State | PA
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