Provider Demographics
NPI:1225360126
Name:MORGAN OXFORD, LLC
Entity Type:Organization
Organization Name:MORGAN OXFORD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-288-0707
Mailing Address - Street 1:5363 OXFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-1123
Mailing Address - Country:US
Mailing Address - Phone:215-288-0707
Mailing Address - Fax:215-288-9360
Practice Address - Street 1:1501 NORTH BROAD STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-3319
Practice Address - Country:US
Practice Address - Phone:215-288-0707
Practice Address - Fax:215-288-9360
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORGAN OXFORD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA050054267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010250400001Medicaid
PAD71633Medicare UPIN
PA0010250400001Medicaid