Provider Demographics
NPI:1609899210
Name:DERK, CHRIS T (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:T
Last Name:DERK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:14TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4208
Mailing Address - Country:US
Mailing Address - Phone:215-662-2454
Mailing Address - Fax:215-955-2420
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:SUITE 600
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4208
Practice Address - Country:US
Practice Address - Phone:215-662-2454
Practice Address - Fax:215-923-5828
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060853L207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005398Medicaid
PA001961082Medicaid
PA0005398Medicaid