MEDICARE: DREXEL

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	282N00000X	General Acute Care Hospital	MT 197045	PA

General Provider Information

NPI Number	:	1417269887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREXEL

Provider Business Mailing Address
First Line	:	777 S BROAD ST
Second Line	:	210
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-2504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-2504
Country	:	US
Telephone Number	:	787-462-2089
Fax Number	:

Authorized Official
Title or Position	:	INTERN
Name	:	DR. JONATHAN GUERRA
Credential	:
Telephone Number	:	787-462-2089

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	07/13/2010

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Directions to “DREXEL ” Practice Location

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