MEDICARE: TOWER DREXEL ACADEMIC MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	103T00000X	Psychologist
3	2084P0800X	Psychiatry Physician
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1811530512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWER DREXEL ACADEMIC MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 13579
Second Line	:
City	:	READING
State	:	PA
Zip	:	19612-3579
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1427 VINE ST FL 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1031
Country	:	US
Telephone Number	:	610-743-6049
Fax Number	:

Authorized Official
Title or Position	:	VP OF REVENUE INTEGRITY
Name	:	CHARLES MICHAEL VALENTINO JR.
Credential	:
Telephone Number	:	484-628-9380

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	06/02/2026

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