Healthcare Provider Details

I. General information

NPI: 1245282235
Provider Name (Legal Business Name): PAOLI FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 LANCASTER AVE SUITE 120
PAOLI PA
19301
US

IV. Provider business mailing address

250 LANCASTER AVE SUITE 120
PAOLI PA
19301
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-8069
  • Fax: 610-644-6736
Mailing address:
  • Phone: 610-644-8069
  • Fax: 610-644-6736

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: ERNEST F GILLAN
Title or Position: PARTNER OWNER
Credential: MD
Phone: 610-644-8069