Healthcare Provider Details

I. General information

NPI: 1427508670
Provider Name (Legal Business Name): WARE MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CHERRY TREE RD
UPPER CHICHESTER PA
19014-2406
US

IV. Provider business mailing address

400 CHERRY TREE RD
UPPER CHICHESTER PA
19014-2406
US

V. Phone/Fax

Practice location:
  • Phone: 610-485-6700
  • Fax:
Mailing address:
  • Phone: 610-485-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberSP016510
License Number StatePA

VIII. Authorized Official

Name: MS. GINA MARIE SLOBOGIN
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 610-633-0073