Healthcare Provider Details

I. General information

NPI: 1740448463
Provider Name (Legal Business Name): MICHELLE ANN-MARIE HEPBURN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 WEST SPROUL ROAD HEALTH PLEX SUITE 205
SPRINGFIELD PA
19064
US

IV. Provider business mailing address

196 WEST SPROUL ROAD HEALTH PLEX SUITE 205
SPRINGFIELD PA
19064
US

V. Phone/Fax

Practice location:
  • Phone: 610-604-0888
  • Fax:
Mailing address:
  • Phone: 610-604-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT190873
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD441028
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: