Provider Demographics
NPI:1932394095
Name:DRELICH, DOUGLASS ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLASS
Middle Name:ALAN
Last Name:DRELICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 CHESTNUT STREET
Mailing Address - Street 2:SUITE 1321
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4310
Mailing Address - Country:US
Mailing Address - Phone:215-955-4730
Mailing Address - Fax:215-503-9188
Practice Address - Street 1:1015 CHESTNUT STREET
Practice Address - Street 2:SUITE 1321
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4310
Practice Address - Country:US
Practice Address - Phone:215-955-4730
Practice Address - Fax:215-503-9188
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438059207RH0000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102343024Medicaid
NJ0205141Medicaid
PA161172Medicare PIN