Basic Information
| Provider Information | |||||||||
| NPI: | 1881909190 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHILDREN'S HOSPITAL OF PHILADELPHIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 PINE ST APT 4A | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191036468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244220720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 34TH STREET AND CIVIC CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155901000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2010 | ||||||||
| LastUpdateDate: | 08/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | ALTSCHULER | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CHIEF EXECUTIVE OFFIC | ||||||||
| AuthorizedOfficialTelephone: | 2155901000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 281PC2000X | MA052562 | PA | Y | Hospitals | Chronic Disease Hospital | Children |
No ID Information.