MEDICARE: IVA ALYXANDER HACKER-DELANY M.D.

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	207P00000X	Emergency Medicine Physician	MD451523	PA

General Provider Information

NPI Number	:	1689986929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVA ALYXANDER HACKER-DELANY M.D.

Provider Business Mailing Address
First Line	:	1601 CHERRY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1320
Country	:	US
Telephone Number	:	215-255-7822
Fax Number	:	215-255-7825

Provider Business Practice Location Address
First Line	:	1600 W GIRARD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1615
Country	:	US
Telephone Number	:	215-762-3808
Fax Number	:	215-762-1307

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

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	02/04/2016

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