MEDICARE: ALLEGHENY AVENUE PEDIATRIC CENTER

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	208000000X	Pediatrics Physician	MD033660E	PA

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

General Provider Information

NPI Number	:	1770539678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGHENY AVENUE PEDIATRIC CENTER

Provider Business Mailing Address
First Line	:	2623 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-5131
Country	:	US
Telephone Number	:	215-423-2030
Fax Number	:	215-423-2340

Provider Business Practice Location Address
First Line	:	2623 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-5131
Country	:	US
Telephone Number	:	215-423-2030
Fax Number	:	215-423-2340

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM FRANCIS O'CONNELL
Credential	:	M.D.
Telephone Number	:	215-423-2030

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	08/22/2020

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Directions to “ALLEGHENY AVENUE PEDIATRIC CENTER ” Practice Location

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