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Organization
THE WEDGE MEDICAL CENTER, P.C.
Active
Organization
THE WEDGE MEDICAL CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAKISA S GALLMAN (ADMINISTRATIVE DIRECTOR)
(215) 276-3922
Entity
Organization
Contact information
Practice address
3609 N BROAD ST, PHILADELPHIA, PA 19140-4107
(215) 223-1100
(215) 223-1200
Mailing address
3609 N BROAD ST, PHILADELPHIA, PA 19140-4107
(215) 223-1100
(215) 223-1200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
807376
PA
101YP2500X
Professional Counselor
Primary
807376
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007281920005
—
PA
05
—
1007281920009
—
PA
Enumeration date
04/19/2007
Last updated
09/11/2025
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