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Specialty details in registry · Philadelphia, PA

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At a glance

125 S 9Th St, Philadelphia, PA 19107-5125

NPPES record updated Aug 22, 2020. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

125 S 9Th St Suite 400
Philadelphia, PA 19107-5125
Professional details: NPI, taxonomy & registry record
NPI1790864312
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
251B00000X
Enumeration date
Nov 3, 2006
Record updated
Aug 22, 2020
More registry details
Provider type
Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

251B00000X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

125 S 9Th St
Suite 400
Philadelphia, PA 19107-5125
Phone
(267) 765-2001
Fax
(267) 765-2019
Mailing address
125 S 9TH ST
SUITE 400
PHILADELPHIA, PA 191075125
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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