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Organization
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Active
Organization
TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Active
Other names
Temple Internal Medicine Associates MIC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TONYA M WOODARD (CREDENTIALING/MANAGER)
(215) 707-3911
Entity
Organization
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-1622
(215) 707-0943
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-1622
(215) 707-0943
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
PA
207RI0008X
Hepatology Physician
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007780130105
—
PA
05
—
1007780130726
—
PA
05
—
1007780130728
—
PA
05
—
1007780130729
—
PA
05
—
1007780130734
—
PA
05
—
1007780130740
—
PA
Enumeration date
10/06/2005
Last updated
06/15/2018
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