Healthcare Provider Details

I. General information

NPI: 1851444269
Provider Name (Legal Business Name): CAROL F ACTOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 MAIN ST SUITE 201
PHOENIXVILLE PA
19460-4459
US

IV. Provider business mailing address

826 MAIN ST SUITE 201
PHOENIXVILLE PA
19460-4459
US

V. Phone/Fax

Practice location:
  • Phone: 610-415-1100
  • Fax: 610-415-1101
Mailing address:
  • Phone: 610-415-1100
  • Fax: 610-415-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD433243
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: