Healthcare Provider Details

I. General information

NPI: 1114905817
Provider Name (Legal Business Name): ROSS H FICHTHORN PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7173 BARNVILLE RD
BERNVILLE PA
19506
US

IV. Provider business mailing address

7173 BARNVILLE RD
BERNVILLE PA
19506
US

V. Phone/Fax

Practice location:
  • Phone: 610-488-6291
  • Fax: 610-488-0534
Mailing address:
  • Phone: 610-488-6291
  • Fax: 610-488-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA000137L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: