Provider Demographics
NPI:1659315380
Name:PHILADELPHIA VA CLINIC
Entity Type:Organization
Organization Name:PHILADELPHIA VA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-254-0339
Mailing Address - Street 1:214 NORTH 4TH ST.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106
Mailing Address - Country:US
Mailing Address - Phone:215-923-1163
Mailing Address - Fax:215-923-4032
Practice Address - Street 1:214 NORTH 4TH ST.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106
Practice Address - Country:US
Practice Address - Phone:215-923-1163
Practice Address - Fax:215-923-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA