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	207ND0900X	Dermatopathology Physician		NJ

General Provider Information

NPI Number	:	1942345095
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	:	19102-1321
Country	:	US
Telephone Number	:	215-255-7822
Fax Number	:	215-255-7825

Provider Business Practice Location Address
First Line	:	112 WHITE HORSE PIKE
Second Line	:
City	:	HADDON HEIGHTS
State	:	NJ
Zip	:	08035-1908
Country	:	US
Telephone Number	:	856-546-5353
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PAYER CONTRACTING
Name	:	DAVID JANIEC
Credential	:
Telephone Number	:	215-255-7766

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	06/18/2014

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Directions to “DREXEL UNIVERSITY ” Practice Location

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