Provider Demographics
NPI:1477680874
Name:DREXEL HILL PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:DREXEL HILL PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-623-9080
Mailing Address - Street 1:400 S STATE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-1243
Mailing Address - Country:US
Mailing Address - Phone:610-623-9080
Mailing Address - Fax:610-623-3861
Practice Address - Street 1:400 S STATE RD STE 210
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1243
Practice Address - Country:US
Practice Address - Phone:610-623-9080
Practice Address - Fax:610-623-3861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010976940003Medicaid