Healthcare Provider Details

I. General information

NPI: 1497660674
Provider Name (Legal Business Name): DOC ON THE BLOCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W VILLAGE LN
CHADDS FORD PA
19317-7321
US

IV. Provider business mailing address

409 W VILLAGE LN
CHADDS FORD PA
19317-7321
US

V. Phone/Fax

Practice location:
  • Phone: 610-368-2987
  • Fax:
Mailing address:
  • Phone: 610-368-2987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA P BROYLES
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 610-368-2987