Provider Demographics
NPI:1528149697
Name:FLAKE, ALAN W (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:W
Last Name:FLAKE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:THE WANAMAKER BUILDING 9TH FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9538
Mailing Address - Fax:267-425-9552
Practice Address - Street 1:34TH & CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-590-2730
Practice Address - Fax:215-590-4875
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-03-13
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Provider Licenses
StateLicense IDTaxonomies
PAMD059803L208600000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001512961Medicaid
PA068059J5PMedicare ID - Type Unspecified
PA001512961Medicaid