Healthcare Provider Details

I. General information

NPI: 1285916130
Provider Name (Legal Business Name): LR FAMILY MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 CHICHESTER AVE
ASTON PA
19014-2327
US

IV. Provider business mailing address

9 CELLA DR
UPPER CHICHESTER PA
19014-2329
US

V. Phone/Fax

Practice location:
  • Phone: 610-497-1725
  • Fax:
Mailing address:
  • Phone: 610-459-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAKAMBINI D. RECLA
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 610-459-2373