Healthcare Provider Details

I. General information

NPI: 1245436575
Provider Name (Legal Business Name): ALAN LEE MAGNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2007
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 N. 20TH ST.
PHILADELPHIA PA
19121
US

IV. Provider business mailing address

1558 BUD LANE
YARDLEY PA
19067-5749
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-2973
  • Fax: 215-765-2409
Mailing address:
  • Phone: 610-517-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0129476E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: