| NPI | 1114481504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTE L JACKSON Enrollment Coor 215-662-6187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2022-10-10 |