Provider Demographics
NPI:1316133424
Name:CHOP CLINICAL ASSOCIATES
Entity type:Organization
Organization Name:CHOP CLINICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BUSINESS SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:DEIRDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-426-5722
Mailing Address - Street 1:34TH & CIVIC CENTER BLVD
Mailing Address - Street 2:PARC BUSINESS SERVICES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4306
Mailing Address - Country:US
Mailing Address - Phone:267-426-5722
Mailing Address - Fax:267-426-7138
Practice Address - Street 1:34TH & CIVIC CENTER BLVD
Practice Address - Street 2:PARC BUSINESS SERVICES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:267-426-5722
Practice Address - Fax:267-426-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA393303OtherMEDICARE