Provider Demographics
NPI:1780227488
Name:TOWER DREXEL ACADEMIC MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:TOWER DREXEL ACADEMIC MEDICAL GROUP LLC
Other - Org Name:INTERNAL MEDICINE TOWER HEALTH MEDICAL GROUP BROAD STREET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP FINANCIAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:EHINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-628-4681
Mailing Address - Street 1:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:610-743-6049
Mailing Address - Fax:
Practice Address - Street 1:219 N BROAD ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1519
Practice Address - Country:US
Practice Address - Phone:610-743-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3400P26OtherMC ID