Organization
FOX CHASE CANCER CENTER MEDICAL GROUP, INC
Active
Other names
PATH Assoc of FCCC, MGI
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA WOODARD (CREDENTIALING/MANAGER)
(215) 707-3911
Entity
Organization
Contact information
Practice address
333 COTTMAN AVE, FOX CHASE CANCER CENTER, PHILADELPHIA, PA 19111-2434
(215) 728-3675
(215) 214-3901
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 728-3675
(215) 728-2848
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZP0101X
Anatomic Pathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026888280020
—
PA
05
—
1026888280026
—
PA
Enumeration date
03/06/2012
Last updated
06/14/2018
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