Healthcare Provider Details

I. General information

NPI: 1255439683
Provider Name (Legal Business Name): MICHAEL J WARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 WOODVIEW RD STE 210
WEST GROVE PA
19390-9301
US

IV. Provider business mailing address

455 WOODVIEW RD STE 210
WEST GROVE PA
19390-9301
US

V. Phone/Fax

Practice location:
  • Phone: 610-345-0977
  • Fax: 610-345-0986
Mailing address:
  • Phone: 610-345-0977
  • Fax: 610-902-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD067134L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: