| Fox Chase Cancer Center Medical Group Inc, | |
|
333 Cottman Ave Philadelphia PA 19111-2434 | |
| (215) 214-1424 | |
| (215) 214-1425 |
| Full Name | Fox Chase Cancer Center Medical Group Inc, |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 333 Cottman Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Tonya Woodard (CREDENTIALING/MANAGER) |
| Authorized Official Contact | 2157073911 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fox Chase Cancer Center Medical Group Inc, 2450 W Hunting Park Ave Philadelphia PA 19129-1302 Ph: (215) 214-1424 | Fox Chase Cancer Center Medical Group Inc, 333 Cottman Ave Philadelphia PA 19111-2434 Ph: (215) 214-1424 |
| NPI Number | 1417221607 |
|---|---|
| Provider Enumeration Date | 03/06/2012 |
| Last Update Date | 06/14/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417221607 | NPI | - | NPPES |
| 1026888280012 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (Pennsylvania) | Primary |
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