Healthcare Provider Details

I. General information

NPI: 1194797688
Provider Name (Legal Business Name): SPRINGFIELD MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 BETHLEHEM PIKE A 108
FLOURTOWN PA
19031-1111
US

IV. Provider business mailing address

1811 BETHLEHEM PIKE A 108
FLOURTOWN PA
19031-1111
US

V. Phone/Fax

Practice location:
  • Phone: 215-233-1500
  • Fax: 215-233-1015
Mailing address:
  • Phone: 215-233-1500
  • Fax: 215-233-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberOS003048L
License Number StatePA

VIII. Authorized Official

Name: DR. GERALD L SHOMER
Title or Position: PHYSCIAN
Credential: D.O.
Phone: 215-233-1500