Organization
FOX CHASE CANCER CENTER MEDICAL GROUP, INC
Active
Other names
Psych 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) 728-3940
(215) 214-3901
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 214-3940
(215) 214-1425
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026888280001
—
PA
Enumeration date
03/07/2012
Last updated
06/14/2018
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