Provider Demographics
NPI:1740361286
Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL OF PHILADELPHIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:467-426-6940
Mailing Address - Street 1:39TH AND CHESTNUT STREETS
Mailing Address - Street 2:ST. LEONARD'S COURT. SUITE 110
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-590-5090
Mailing Address - Fax:215-590-5048
Practice Address - Street 1:39TH & CHESTNUT STREET
Practice Address - Street 2:ST LEONARDS COURT. SUITE 110
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-5090
Practice Address - Fax:215-590-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007709910012Medicaid