Healthcare Provider Details

I. General information

NPI: 1255313292
Provider Name (Legal Business Name): AMY L. HOUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY BETZ

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 AIRPORT RD STE 134
HAZLE TOWNSHIP PA
18202-3361
US

IV. Provider business mailing address

100 N ACADEMY AVE CREDENTAILS DEPT
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-7512
  • Fax: 570-501-7515
Mailing address:
  • Phone: 570-271-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD070897L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: