Healthcare Provider Details

I. General information

NPI: 1962459172
Provider Name (Legal Business Name): FAMILY MEDICAL ASSOCIATES OF HIGHLAND PARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 FROSTY HOLLOW RD
LEVITTOWN PA
19056-2404
US

IV. Provider business mailing address

1310 FROSTY HOLLOW RD
LEVITTOWN PA
19056-2404
US

V. Phone/Fax

Practice location:
  • Phone: 215-949-6622
  • Fax: 215-949-8357
Mailing address:
  • Phone: 215-949-6622
  • Fax: 215-949-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAWN MARIE GREGORY
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-949-6622