| Temple Gastroenterology | |
|
3401 N Broad St Philadelphia PA 19140-5103 | |
| (215) 707-9900 | |
| (215) 707-3831 |
| Full Name | Temple Gastroenterology |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 3401 N Broad St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Tonya M Woodard (CREDENTIALING/MANAGER) |
| Authorized Official Contact | 2157073911 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Temple Gastroenterology 2450 W Hunting Park Ave Philadelphia PA 19129-1302 Ph: (215) 707-9900 | Temple Gastroenterology 3401 N Broad St Philadelphia PA 19140-5103 Ph: (215) 707-9900 |
| NPI Number | 1093703910 |
|---|---|
| Provider Enumeration Date | 10/13/2005 |
| Last Update Date | 06/15/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093703910 | NPI | - | NPPES |
| 1007780130061 | Medicaid | PA | |
| 1007780130724 | Medicaid | PA | |
| 1007780130732 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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