Healthcare Provider Details

I. General information

NPI: 1497887988
Provider Name (Legal Business Name): GREEN HILLS FAMILY MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 MORGANTOWN ROAD
READING PA
19607
US

IV. Provider business mailing address

1903 MORGANTOWN ROAD
READING PA
19607
US

V. Phone/Fax

Practice location:
  • Phone: 610-777-4040
  • Fax: 610-777-5575
Mailing address:
  • Phone: 610-777-4040
  • Fax: 610-777-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. DIANE T. BONACCORSI
Title or Position: MD/OWNER
Credential: M.D.
Phone: 610-777-4040