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	2084P0800X	Psychiatry 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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538157656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Provider Business Mailing Address
First Line	:	2450 W HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1302
Country	:	US
Telephone Number	:	215-707-8496
Fax Number	:	215-707-4086

Provider Business Practice Location Address
First Line	:	100 E LEHIGH AVE BLDG SUITE105
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1012
Country	:	US
Telephone Number	:	215-707-8496
Fax Number	:	215-707-4086

Authorized Official
Title or Position	:	MANAGER, CREDENTIALING
Name	:	TONYA WOODARD
Credential	:
Telephone Number	:	215-707-3911

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	06/15/2018

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Directions to “TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION ” Practice Location

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