NPIMap

Organization Active NPI

Fox Chase Cancer Center Medical Group, Inc

  • Plastic and Reconstructive Surgery Physician
  • Philadelphia, PA
National Provider Identifier
1083988166
Registry record updated Jun 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
FOX CHASE CANCER CENTER MEDICAL GROUP, INC
Practice address
333 Cottman Ave
Fox Chase Cancer Center
Philadelphia, PA 19111-2434
Phone
(215) 728-6900
Fax
(215) 728-5507
NPI assigned
Mar 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tonya Woodard
Title
Credentialing/Manager
Phone
(215) 707-3911

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X
Plastic and Reconstructive Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0122X Primary

Addresses

Primary practice location

333 Cottman Ave
Fox Chase Cancer Center
Philadelphia, PA 19111-2434

Mailing address

2450 W Hunting Park Ave
Philadelphia, PA 19129-1302
Phone (215) 728-6900

Other practice location 1

2701 Dekalb Pike
Norristown, PA 19401-1820
Phone (888) 369-2487

Other practice location 2

2365 Heritage Center Dr
Furlong, PA 18925-1280
Phone (215) 782-6900

Other identifiers 3

IdentifierTypeStateIssuer
1026888280019MedicaidPA
1026888280037MedicaidPA
1026888280029MedicaidPA

Other names 1

  • Plastic/Recon Assoc of FCCC, MGI Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528934400000",
    "number": "1083988166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-728-6900",
            "fax_number": "215-728-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 COTTMAN AVE",
            "address_2": "FOX CHASE CANCER CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112434",
            "telephone_number": "215-728-6900",
            "fax_number": "215-728-5507"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2701 Dekalb Pike",
            "address_purpose": "LOCATION",
            "city": "Norristown",
            "state": "PA",
            "postal_code": "194011820",
            "country_code": "US",
            "telephone_number": "888-369-2487",
            "fax_number": "215-728-5507",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2365 Heritage Center Dr",
            "address_purpose": "LOCATION",
            "city": "Furlong",
            "state": "PA",
            "postal_code": "189251280",
            "country_code": "US",
            "telephone_number": "215-782-6900",
            "fax_number": "215-728-5507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOX CHASE CANCER CENTER MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-07",
        "last_updated": "2018-06-14",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "CREDENTIALING/MANAGER",
        "authorized_official_telephone_number": "215-707-3911"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026888280019",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026888280037",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026888280029",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plastic/Recon Assoc of FCCC, MGI",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Plastic/Recon Assoc of FCCC, MGI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.