Organization
CHOP CLINICAL ASSOCIATES
Active
Organization
CHOP CLINICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIERDRA YOUNG (DIRECTOR, BUSINESS OFFICE)
(267) 426-5722
Entity
Organization
Contact information
Practice address
34TH & CIVIC CENTER BLVD., PARC BUSINESS OFFICE, PHILADELPHIA, PA 19104
(267) 426-5722
(267) 426-6325
Mailing address
34TH & CIVIC CENTER BLVD., PARC BUSINESS OFFICE, PHILADELPHIA, PA 19104
(267) 426-5722
(267) 426-6325
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001166000
IBC
PA
01
—
0001426
AETNA/US HEALTHCARE
PA
01
—
23-1352166-081
PRUDENTIAL HEALTH CARE
PA
01
—
393303
KEYSTONE HEALTH PLAN EAST
PA
05
—
4204301
—
PA
05
—
60008
—
PA
Enumeration date
08/18/2006
Last updated
08/22/2020
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