Healthcare Provider Details

I. General information

NPI: 1073731014
Provider Name (Legal Business Name): MED CENTER 100
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N. POTTSTOWN PIKE
EXTON PA
19341
US

IV. Provider business mailing address

625 N. POTTSTOWN PIKE
EXTON PA
19341
US

V. Phone/Fax

Practice location:
  • Phone: 610-903-0640
  • Fax: 610-903-0637
Mailing address:
  • Phone: 610-903-0640
  • Fax: 610-903-0637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
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: MS. CHERYL MITMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 610-903-0643