Provider Demographics
NPI:1063463073
Name:DREXEL COLLEGE OF MEDICINE
Entity type:Organization
Organization Name:DREXEL COLLEGE OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-762-3500
Mailing Address - Street 1:245 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1101
Mailing Address - Country:US
Mailing Address - Phone:215-762-4984
Mailing Address - Fax:215-762-3053
Practice Address - Street 1:245 N 15TH ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1101
Practice Address - Country:US
Practice Address - Phone:215-762-4984
Practice Address - Fax:215-762-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA029146E282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010726590007Medicaid
PAC34575Medicare UPIN
PA0010726590007Medicaid