Basic Information
| Provider Information | |||||||||
| NPI: | 1932394095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRELICH | ||||||||
| FirstName: | DOUGLASS | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 CHESTNUT STREET | ||||||||
| Address2: | SUITE 1321 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159554730 | ||||||||
| FaxNumber: | 2155039188 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 CHESTNUT STREET | ||||||||
| Address2: | SUITE 1321 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159554730 | ||||||||
| FaxNumber: | 2155039188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2007 | ||||||||
| LastUpdateDate: | 12/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0000X | MD438059 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RH0003X | MD438059 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 102343024 | 05 | PA | MEDICAID | 0205141 | 05 | NJ | MEDICAID |