Healthcare Provider Details

I. General information

NPI: 1134195688
Provider Name (Legal Business Name): DETWEILER FAMILY MEDICINE & ASSO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 NORTH BROAD STREET
LANSDALE PA
19446
US

IV. Provider business mailing address

1970 NORTH BROAD STREET
LANSDALE PA
19446
US

V. Phone/Fax

Practice location:
  • Phone: 215-368-1900
  • Fax: 215-368-8772
Mailing address:
  • Phone: 215-368-1900
  • Fax: 215-368-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT O DETWEILER
Title or Position: PRESIDENT
Credential: DO
Phone: 215-868-1900