Individual
CHARLENE M BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8500 HENRY AVE, TPI HENRY AVENUE PEDIATRICS, PHILADELPHIA, PA 19128-2111
(215) 483-8865
(215) 483-8027
Mailing address
2450 W HUNTING PARK AVE, 2ND FLOOR TPI, PHILADELPHIA, PA 19129-1302
(215) 926-9019
(215) 226-8286
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD022704E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016346
AETNA HMO
PA
01
—
0055530000
INDEPENDENCE BLUE CROSS
PA
01
—
102057
HIGHMARK BLUE SHIELD
PA
01
—
30030891
KEYSTONE MERCY HEALTH PLA
PA
01
—
3Y7184
HEALTH NET
PA
01
—
436710
COVENTRY HEALTH AMERICA
PA
01
—
5406099
AETNA PPO
PA
Enumeration date
06/14/2006
Last updated
08/14/2007
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