Provider Demographics
NPI:1811945538
Name:ST. CHRISTOPHER'S PEDIATRIC ASSOCIATES
Entity type:Organization
Organization Name:ST. CHRISTOPHER'S PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-427-3725
Mailing Address - Street 1:FRONT STREET AT ERIE AVENUE
Mailing Address - Street 2:SUITE 2205
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134
Mailing Address - Country:US
Mailing Address - Phone:215-427-8915
Mailing Address - Fax:215-427-4603
Practice Address - Street 1:FRONT STREET AT ERIE AVE.
Practice Address - Street 2:SUITE 2205
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134
Practice Address - Country:US
Practice Address - Phone:215-427-8915
Practice Address - Fax:215-427-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021329E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0078325302Medicaid
PAB34317Medicare UPIN
PA046804Medicare ID - Type UnspecifiedINDIVIDUAL
PA0078325302Medicaid