Provider Demographics
NPI:1033693718
Name:REVOLUTION PS, P.C.
Entity type:Organization
Organization Name:REVOLUTION PS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-372-5000
Mailing Address - Street 1:1601 WALNUT ST STE 208
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2902
Mailing Address - Country:US
Mailing Address - Phone:215-372-5000
Mailing Address - Fax:215-372-6000
Practice Address - Street 1:1601 WALNUT ST STE 208
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2902
Practice Address - Country:US
Practice Address - Phone:215-372-5000
Practice Address - Fax:215-372-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty