Basic Information
| Provider Information | |||||||||
| NPI: | 1437367398 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AZAM | ||||||||
| FirstName: | ANITA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 A. STREET | ||||||||
| Address2: | ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN - ENDOCRINOLOGY | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154275000 | ||||||||
| FaxNumber: | 2154278105 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 A. STREET | ||||||||
| Address2: | ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154278100 | ||||||||
| FaxNumber: | 2154278105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 81095 | MT | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | 2080P0205X | 2007-01232 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.