Healthcare Provider Details

I. General information

NPI: 1306908918
Provider Name (Legal Business Name): MARIA CONWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 MEDICAL DRIVE SUITE E
POTTSTOWN PA
19464
US

IV. Provider business mailing address

1590 MEDICAL DRIVE SUITE E
POTTSTOWN PA
19464
US

V. Phone/Fax

Practice location:
  • Phone: 610-326-4980
  • Fax: 610-326-4435
Mailing address:
  • Phone: 610-326-4980
  • Fax: 610-326-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD052100L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0017871300006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: