Basic Information
Provider Information
NPI: 1770894040
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VERMA
FirstName: ARCHANA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 E PENN SQ
Address2: 9TH FL
City: PHILADELPHIA
State: PA
PostalCode: 191073323
CountryCode: US
TelephoneNumber: 2674259258
FaxNumber: 2674259299
Practice Location
Address1: 3401 CIVIC CENTER BLVD
Address2: CHILDREN'S HOSPITAL OF PHILADELPHIA - EMERGENCY MED
City: PHILADELPHIA
State: PA
PostalCode: 191044319
CountryCode: US
TelephoneNumber: 2155901944
FaxNumber: 2155904454
Other Information
ProviderEnumerationDate: 07/01/2010
LastUpdateDate: 10/22/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X257564-1NYN Allopathic & Osteopathic PhysiciansPediatrics 
208000000XMD452279PAN Allopathic & Osteopathic PhysiciansPediatrics 
2080P0204XMD452279PAY Allopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
208000000X25MA09529000NJN Allopathic & Osteopathic PhysiciansPediatrics 
2080P0204X25MA09529000NJN Allopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine

No ID Information.


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