# FOX CHASE CANCER CENTER MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pain Mana Assoc of FCCC, MGI
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487928636
- **Authorized official:** TONYA WOODARD (CREDENTIALING/MANAGER)
- **Authorized official phone:** (215) 707-3911

## Contact information

- **Practice address:** 333 COTTMAN AVE, FOX CHASE CANCER CENTER, PHILADELPHIA, PA 19111-2434
- **Practice address phone:** (215) 728-3544
- **Practice address fax:** (215) 214-3901
- **Mailing address:** 2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
- **Mailing address phone:** (215) 728-3544
- **Mailing address fax:** (215) 728-2887

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 03/06/2012
- **Last updated:** 06/14/2018