Individual
EDITH D HASBROUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1200 W TABOR RD, SUITE 141, PHILADELPHIA, PA 19141-3019
(215) 456-9142
(215) 456-9052
Mailing address
1200 TABOR ROAD SUITE 141, MOSS-CADD, PHILADELPHIA, PA 19150
(215) 456-9142
(215) 456-9052
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
MD031068E
PA
208000000X
Pediatrics Physician
MD031068E
PA
Other
Enumeration date
11/28/2006
Last updated
07/28/2015
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