Organization
WEDGE MEDICAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAKISA S. GALLMAN B.S. (ADMINISTRATIVE DIRECTOR)
(215) 276-3922
Entity
Organization
Contact information
Practice address
4243 FRANKFORD AVENUE, PHILADELPHIA, PA 19124
(215) 744-3600
(215) 744-1400
Mailing address
6701 N BROAD ST, PHILADELPHIA, PA 19126-2837
(215) 276-3922
(215) 276-8199
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
807343
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100728192
—
PA
Enumeration date
02/12/2009
Last updated
02/12/2009
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