Provider Demographics
NPI:1356383673
Name:CHILDS, USHA MATHEW (MD)
Entity type:Individual
Prefix:MRS
First Name:USHA
Middle Name:MATHEW
Last Name:CHILDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 W WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3715
Mailing Address - Country:US
Mailing Address - Phone:215-849-2204
Mailing Address - Fax:
Practice Address - Street 1:536 WALNUT LN
Practice Address - Street 2:REAR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1741
Practice Address - Country:US
Practice Address - Phone:215-482-3510
Practice Address - Fax:215-482-5695
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024090E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0730170Medicaid
B41254Medicare UPIN
PA403933Medicare ID - Type Unspecified