Healthcare Provider Details

I. General information

NPI: 1699353920
Provider Name (Legal Business Name): HOME VISITING PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 BALLANTINE LN
WARRINGTON PA
18976-2738
US

IV. Provider business mailing address

2017 BALLANTINE LN
WARRINGTON PA
18976-2738
US

V. Phone/Fax

Practice location:
  • Phone: 215-233-9842
  • Fax: 215-233-9488
Mailing address:
  • Phone: 215-233-9842
  • Fax: 215-233-9488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON GOFT
Title or Position: ADMINISTRATOR
Credential:
Phone: 215-771-7277