Provider Demographics
NPI:1386646891
Name:TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Entity Type:Organization
Organization Name:TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Other - Org Name:TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE AMBULATORY SURGICAL CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-625-5310
Mailing Address - Street 1:PO BOX 827282
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7282
Mailing Address - Country:US
Mailing Address - Phone:215-625-5341
Mailing Address - Fax:215-629-0716
Practice Address - Street 1:8TH AT RACE STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-0000
Practice Address - Country:US
Practice Address - Phone:215-625-5381
Practice Address - Fax:215-629-4904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-15
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15661501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100778013-0691Medicaid
PA735070OtherHEALTH AMERICA HEALTH ASSURANCE/ COVENTRY/ FIRST HEALTH
PAHU833OtherINTER COUNTY HEALTH PLAN
PAU833OtherKEYSTONE MERCY/ AMERI HEALTH
PA37394OtherHEALTH PARTNERS
PA116487100OtherUS DEPARTMENT OF LABOR
PA2063664OtherBLUE SHIELD
PA=========OtherUNITED HEALTH CARE
PA116487100OtherUS DEPARTMENT OF LABOR
PA=========OtherFOCUS
PA735070OtherHEALTH AMERICA HEALTH ASSURANCE/ COVENTRY/ FIRST HEALTH
PAHU833OtherINTER COUNTY HEALTH PLAN
PA081065Medicare ID - Type Unspecified