Provider Demographics
NPI:1003353046
Name:HAHNEMANN UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:HAHNEMANN UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, EDUCATION & BUSINESS OP.
Authorized Official - Prefix:
Authorized Official - First Name:DURANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIGREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-762-2366
Mailing Address - Street 1:230 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4103 TERSHER DR
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-5613
Practice Address - Country:US
Practice Address - Phone:267-240-5745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-29
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty