Provider Demographics
NPI:1326188970
Name:PHILADELPHIA VA MEDICA CENTER
Entity Type:Organization
Organization Name:PHILADELPHIA VA MEDICA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-823-5800
Mailing Address - Street 1:4816 PINE ST
Mailing Address - Street 2:APT B202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1721
Mailing Address - Country:US
Mailing Address - Phone:215-748-1346
Mailing Address - Fax:
Practice Address - Street 1:PADRECC , PHILADELPHIA VA MEDICAL CENTER
Practice Address - Street 2:UNIVERSITY AND WOODLAND AVENUE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:215-823-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH086131261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty