Healthcare Provider Details

I. General information

NPI: 1881158871
Provider Name (Legal Business Name): MADELEINE HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MORRIS AVE STE 219
BRYN MAWR PA
19010-3335
US

IV. Provider business mailing address

151 JUNIPER RD
HAVERTOWN PA
19083-5409
US

V. Phone/Fax

Practice location:
  • Phone: 484-883-6827
  • Fax: 484-282-9632
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: