Organization
JEFFERSON UNIVERSITY PHYSICIANS
Active
Other names
Internal Medicine- Dr Park
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN PADGETT (CREDENTIALING MANAGER)
(215) 955-1175
Entity
Organization
Contact information
Practice address
525 W CHESTER PIKE STE 102B, HAVERTOWN, PA 19083-4539
(610) 853-9328
Mailing address
PO BOX 828937, PHILADELPHIA, PA 19182-8937
(215) 503-1240
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0307681005
INDEPENDENCE BLUE CROSS
PA
01
—
3000370
KEYSTONE MERCY
PA
01
—
595787
AETNA
PA
Enumeration date
04/18/2008
Last updated
06/13/2024
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