Healthcare Provider Details

I. General information

NPI: 1366786055
Provider Name (Legal Business Name): HEALTH ACCESS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARTOL AVE SUITE 10
RIDLEY PARK PA
19078-2214
US

IV. Provider business mailing address

PO BOX 8500-6355
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 610-521-0150
  • Fax: 610-521-0567
Mailing address:
  • Phone: 610-497-7520
  • Fax: 610-497-7525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: GERALYN PATERSON
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 610-497-7407