Provider Demographics
NPI:1679953798
Name:PROFESSIONAL HEALTHCARE DYNAMICS
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTHCARE DYNAMICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DITTRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-465-3000
Mailing Address - Street 1:1313 WOLF ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2911
Mailing Address - Country:US
Mailing Address - Phone:215-465-3000
Mailing Address - Fax:215-465-1085
Practice Address - Street 1:1313 WOLF ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2911
Practice Address - Country:US
Practice Address - Phone:215-465-3000
Practice Address - Fax:215-465-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003098L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty