MEDICARE: GRADUATE HOSPITAL DEPT. OF MEDICINE EDUCATION & RESEARCH FOUNDATION

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1891733283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRADUATE HOSPITAL DEPT. OF MEDICINE EDUCATION & RESEARCH FOUNDATION

Provider Business Mailing Address
First Line	:	2136 W PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3415
Country	:	US
Telephone Number	:	215-271-0101
Fax Number	:	215-334-7259

Provider Business Practice Location Address
First Line	:	2136 W PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3415
Country	:	US
Telephone Number	:	215-271-0101
Fax Number	:	215-334-7259

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CHRISTOPHER O. SETZLER
Credential	:	MBA
Telephone Number	:	215-893-7127

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	08/22/2020

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