# TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Temple Pediatric Hematology Oncology Assoc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649300617
- **Authorized official:** TRACEY CLARK (DIRECTOR, GOVERNMENT AND PAYER RELA)
- **Authorized official phone:** (215) 707-4739

## Contact information

- **Practice address:** 3509 N BROAD ST, PHILADELPHIA, PA 19140-4105
- **Practice address phone:** (215) 707-6613
- **Practice address fax:** (215) 707-6629
- **Mailing address:** 3425 N CARLISLE ST, 2ND FL HUDSON BUILDING, PHILADELPHIA, PA 19140-5108
- **Mailing address phone:** (215) 707-3911
- **Mailing address fax:** (215) 707-3677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080P0207X | Pediatric Hematology & Oncology Physician | — | NULL | Yes |
| 2080P0207X | Pediatric Hematology & Oncology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/07/2007
- **Last updated:** 08/22/2020