Healthcare Provider Details

I. General information

NPI: 1841680881
Provider Name (Legal Business Name): ST. JOSEPH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BERNVILLE RD
READING PA
19605-9453
US

IV. Provider business mailing address

2500 BERNVILLE RD PO BOX 316
READING PA
19605-9453
US

V. Phone/Fax

Practice location:
  • Phone: 610-378-2055
  • Fax:
Mailing address:
  • Phone: 610-378-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: EDWARD CHABALOWSKI
Title or Position: CFO
Credential:
Phone: 610-378-2300