MEDICARE: TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104814953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Provider Business Mailing Address
First Line	:	3425 N CARLISLE ST
Second Line	:	2ND FLOOR, HUDSON BUILDING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5108
Country	:	US
Telephone Number	:	215-707-4739
Fax Number	:	215-707-3677

Provider Business Practice Location Address
First Line	:	3509 N BROAD ST
Second Line	:	6TH FLOOR, TUCMC
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4105
Country	:	US
Telephone Number	:	215-707-6617
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. THOMAS G KUPP
Credential	:
Telephone Number	:	215-707-7551

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	04/30/2009

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