Healthcare Provider Details

I. General information

NPI: 1891875456
Provider Name (Legal Business Name): BUXMONT MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 EASTON RD SUITE 2500
WARRINGTON PA
18976-2907
US

IV. Provider business mailing address

847 EASTON RD SUITE 2500
WARRINGTON PA
18976-2907
US

V. Phone/Fax

Practice location:
  • Phone: 215-918-5555
  • Fax: 215-918-5560
Mailing address:
  • Phone: 215-918-5555
  • Fax: 215-918-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY MARK MANDEL
Title or Position: PRACTICE ADMINISTRATOR
Credential: M.D.
Phone: 215-918-5555