Provider Demographics
NPI:1063858124
Name:CHOP CLINICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:CHOP CLINICAL ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-590-5317
Mailing Address - Street 1:301 LINDENWOOD DRIVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355
Mailing Address - Country:US
Mailing Address - Phone:215-590-2897
Mailing Address - Fax:215-590-0325
Practice Address - Street 1:4009 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330
Practice Address - Country:US
Practice Address - Phone:609-677-7895
Practice Address - Fax:609-677-7835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOP CLINICAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-16
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care