Basic Information
| Provider Information | |||||||||
| NPI: | 1467690420 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCFADDEN | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | CLARK | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 820933 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159269010 | ||||||||
| FaxNumber: | 2152268285 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W LEHIGH AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191322701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152268800 | ||||||||
| FaxNumber: | 2152268819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2009 | ||||||||
| LastUpdateDate: | 03/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA20067 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | MA-055882 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | CD4829 | 01 | PA | TPI RAILROAD MEDICARE GROUP | OTHER | W5352 | 01 | CA | UPIN | OTHER | 1007278000 | 01 | PA | PA MEDICAID GROUP | OTHER | 597586 | 01 | PA | TPI MEDICARE GROUP | OTHER |