Provider Demographics
NPI:1770276768
Name:TEMPLE FACULTY PRACTICE PLAN INC
Entity type:Organization
Organization Name:TEMPLE FACULTY PRACTICE PLAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-926-9019
Mailing Address - Street 1:3500 N BROAD ST RM 1A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-4106
Mailing Address - Country:US
Mailing Address - Phone:215-926-9019
Mailing Address - Fax:
Practice Address - Street 1:9433 ROOSEVELT BOULEVARD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-707-2400
Practice Address - Fax:215-707-4034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMPLE FACULTY PRACTICE PLAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty