Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2011-07-14
- Last updated
- 2024-06-12
Specialties
Licenses
- License PA
- MD452979
Location
- Practice location
- 133 LANCASTER AVE
- City
- DEVON PA
- Postal code
- 193331503
- Phone
- 484-581-2990
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.