MEDICARE: DREXEL UNIVERSITY

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	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1821403734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREXEL UNIVERSITY

Provider Business Mailing Address
First Line	:	1601 CHERRY ST
Second Line	:	SUITE 11511
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	:	1601 CHERRY ST
Second Line	:	2ND FLOOR, PARKWAY HEALTH & WELLNESS
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1320
Country	:	US
Telephone Number	:	215-553-7012
Fax Number	:	215-553-7019

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR, REVENUE CYCLE
Name	:	EILEEN MASTERSON-CARR
Credential	:
Telephone Number	:	215-255-7766

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	05/06/2016

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1346641693 — ELIZABETH MANDERS MA, BC-DMT, LPC
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Directions to “DREXEL UNIVERSITY ” Practice Location

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