Healthcare Provider Details

I. General information

NPI: 1548248677
Provider Name (Legal Business Name): RICHARD D. BYRNES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E BROAD ST
SOUDERTON PA
18964-1219
US

IV. Provider business mailing address

650 E BROAD ST
SOUDERTON PA
18964-1219
US

V. Phone/Fax

Practice location:
  • Phone: 215-723-8972
  • Fax: 215-723-8961
Mailing address:
  • Phone: 215-723-8972
  • Fax: 215-723-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS003066L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: