Unknown Individual – Forensic Psychiatry Physician, NPI 1669467692
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2021-08-09. Reason: Fraud, kickbacks, or other prohibited activities.
Forensic Psychiatry Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Center City One, 1326, Spruce Street, Washington Square West, Society Hill, Center City, Philadelphia, Philadelphia County, Pennsylvania, 19107, United States
SUITE 501
PHILADELPHIA, PA 191075826
Phone: (215) 546-4300
Fax: (215) 546-4301
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 19107)
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