Healthcare Provider Details

I. General information

NPI: 1104763861
Provider Name (Legal Business Name): AVANTA PRIMARY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WELSH RD STE 100
HORSHAM PA
19044-2248
US

IV. Provider business mailing address

3956 AMBERTON CT
DOYLESTOWN PA
18902-1242
US

V. Phone/Fax

Practice location:
  • Phone: 267-703-5900
  • Fax: 267-703-2671
Mailing address:
  • Phone: 267-703-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALENA BLAIN
Title or Position: OWNER
Credential: NP
Phone: 917-388-0381