Healthcare Provider Details

I. General information

NPI: 1467646406
Provider Name (Legal Business Name): KRISTIE MARGEVICH RESSLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WEST CHESTER PIKE SUITE 201
HAVERTOWN PA
19083-3442
US

IV. Provider business mailing address

1010 WEST CHESTER PIKE SUITE 201
HAVERTOWN PA
19083-3442
US

V. Phone/Fax

Practice location:
  • Phone: 610-446-7882
  • Fax:
Mailing address:
  • Phone: 610-446-7882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberOS012525
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: