1265544456 NPI number — DRESHER FAMILY MEDICINE, P.C.

Table of content: (NPI 1265544456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265544456 NPI number — DRESHER FAMILY MEDICINE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRESHER FAMILY MEDICINE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265544456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 TWINING RD
Provider Second Line Business Mailing Address:
SUITE #6
Provider Business Mailing Address City Name:
DRESHER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-628-3350
Provider Business Mailing Address Fax Number:
215-628-4137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 TWINING ROAD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
DRESHER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-628-3350
Provider Business Practice Location Address Fax Number:
215-628-4137
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEWCUN
Authorized Official First Name:
MARY LOU
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
215-628-3350

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 033874401 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 383784 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com