Healthcare Provider Details

I. General information

NPI: 1992119309
Provider Name (Legal Business Name): AMY PORTER MILLER BEBAWI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3902
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3902
US

V. Phone/Fax

Practice location:
  • Phone: 610-874-5257
  • Fax: 610-874-7241
Mailing address:
  • Phone: 610-874-5257
  • Fax: 610-874-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberUO4087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: