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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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