MEDICARE: ALEXANDER DUFFY MD

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	207Y00000X	Otolaryngology Physician	MD490457	PA

General Provider Information

NPI Number	:	1639732464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER DUFFY MD

Provider Business Mailing Address
First Line	:	3500 N BROAD ST RM 1A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4106
Country	:	US
Telephone Number	:	215-707-2433
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4105
Country	:	US
Telephone Number	:	844-570-1767
Fax Number	:	215-707-6676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	01/16/2026

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