Provider Demographics
NPI:1932281094
Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Other - Org Name:CHOP ADOLESCENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TODOROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-426-6940
Mailing Address - Street 1:301 LINDENWOOD DRIVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355
Mailing Address - Country:US
Mailing Address - Phone:215-590-2897
Mailing Address - Fax:215-590-0325
Practice Address - Street 1:3550 MARKET STREET
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-3537
Practice Address - Fax:215-590-1493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207V00000X, 208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007709910086Medicaid