Healthcare Provider Details

I. General information

NPI: 1043233893
Provider Name (Legal Business Name): KATHLEEN O'SHEA CROCKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HORIZON DR SUITE 200
CHALFONT PA
18914
US

IV. Provider business mailing address

1700 HORIZON DR SUITE 200
CHALFONT PA
18914
US

V. Phone/Fax

Practice location:
  • Phone: 215-882-7700
  • Fax: 215-822-2296
Mailing address:
  • Phone: 215-882-7700
  • Fax: 215-822-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-071037-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: