Healthcare Provider Details

I. General information

NPI: 1164451738
Provider Name (Legal Business Name): FOUNTAINVILLE MEDICAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1456 FERRY RD STE 600
DOYLESTOWN PA
18901-2391
US

IV. Provider business mailing address

PO BOX 375 5049 SWAMP RD
FOUNTAINVILLE PA
18923-0375
US

V. Phone/Fax

Practice location:
  • Phone: 215-230-8390
  • Fax:
Mailing address:
  • Phone: 215-348-5046
  • Fax: 215-348-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LYNN YATES
Title or Position: BILLING MANAGER
Credential:
Phone: 215-348-5046