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NPI Code Detail

MEDICARE: TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

MEDICARE: TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
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
1261QR0400XRehabilitation Clinic/Center
2208100000XPhysical Medicine & Rehabilitation Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871581991
Entity Type Code : Organization
Provider Name (Legal Business Name) : TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Provider Business Mailing Address
First Line : 2450 W HUNTING PARK AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19129-1302
Country : US
Telephone Number : 215-707-3646
Fax Number : 215-707-6594
Provider Business Practice Location Address
First Line : 3401 N BROAD ST
Second Line : BSMT ROCK PAVILION
City : PHILADELPHIA
State : PA
Zip : 19140-5103
Country : US
Telephone Number : 215-707-3646
Fax Number : 215-707-6594
Authorized Official
Title or Position : CREDENTIALING/MANAGER
Name : TONYA WOODARD
Credential :
Telephone Number : 215-707-3911
Provider Enumeration Date : 10/12/2005
Last Update Date : 06/15/2018

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1821314691 — MRS. HELENE H, C MICAHNIK RD, LDN
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1972185221 — MATTHEW D MARX DNP, FNP-BC
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1568102887 — ASHLEIGH NOELLE PAVLOVIC MD
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Directions to “TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION ” Practice Location

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