MEDICARE: PHILADELPHIA DEPT. OF PUBLIC HEALTH

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	261QP0905X	State or Local Public Health Clinic/Center

General Provider Information

NPI Number	:	1578861605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA DEPT. OF PUBLIC HEALTH

Provider Business Mailing Address
First Line	:	500 S BROAD ST
Second Line	:	SECOND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1613
Country	:	US
Telephone Number	:	215-685-6741
Fax Number	:	215-545-8362

Provider Business Practice Location Address
First Line	:	500 S BROAD ST
Second Line	:	SECOND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1613
Country	:	US
Telephone Number	:	215-685-6741
Fax Number	:	215-545-8362

Authorized Official
Title or Position	:	DIRECTOR, DIV. OF DISEASE CONTROL
Name	:	DR. CAROLINE JOHNSON
Credential	:	M.D.
Telephone Number	:	215-685-6741

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	04/03/2014

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Directions to “PHILADELPHIA DEPT. OF PUBLIC HEALTH ” Practice Location

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