Provider Demographics
NPI:1922054386
Name:FOX CHASE FAMILY MEDICAL CENTER LTD
Entity Type:Organization
Organization Name:FOX CHASE FAMILY MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MALORIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUDMAN-TRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-745-7101
Mailing Address - Street 1:7956 VERREE ROAD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2530
Mailing Address - Country:US
Mailing Address - Phone:215-745-7101
Mailing Address - Fax:215-745-0981
Practice Address - Street 1:7956 VERREE ROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2530
Practice Address - Country:US
Practice Address - Phone:215-745-7101
Practice Address - Fax:215-745-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009602L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01748722Medicaid
H54757Medicare UPIN
PA054663Q9NMedicare ID - Type Unspecified