Provider Demographics
NPI:1639381254
Name:GRAYSFERRY MEDICAL CENTER
Entity type:Organization
Organization Name:GRAYSFERRY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-468-7220
Mailing Address - Street 1:235 N BROAD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1531
Mailing Address - Country:US
Mailing Address - Phone:215-468-7220
Mailing Address - Fax:215-468-7221
Practice Address - Street 1:2501 REED ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19146-3900
Practice Address - Country:US
Practice Address - Phone:215-468-7220
Practice Address - Fax:215-468-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055881L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty