MEDICARE: CLINICAL RESEARCH PHILADELPHIA, LLC

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	261QR1100X	Research Clinic/Center

General Provider Information

NPI Number	:	1497697296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL RESEARCH PHILADELPHIA, LLC

Provider Business Mailing Address
First Line	:	9501 ROOSEVELT BLVD STE 208
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1027
Country	:	US
Telephone Number	:	215-676-6696
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 ROOSEVELT BLVD STE 208
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1027
Country	:	US
Telephone Number	:	215-676-6696
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	ANEESH VAZE
Credential	:
Telephone Number	:	267-234-1643

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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