Healthcare Provider Details

I. General information

NPI: 1467624072
Provider Name (Legal Business Name): BARBARA B HACKMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S VALLEY RD SUITE 205
PAOLI PA
19301-1450
US

IV. Provider business mailing address

30 S VALLEY RD SUITE 205
PAOLI PA
19301-1450
US

V. Phone/Fax

Practice location:
  • Phone: 610-651-7760
  • Fax: 610-651-7767
Mailing address:
  • Phone: 610-651-7760
  • Fax: 610-651-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD072634L
License Number StatePA

VIII. Authorized Official

Name: BARBARA B HACKMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 610-651-7760