Healthcare Provider Details

I. General information

NPI: 1720425929
Provider Name (Legal Business Name): ATLANTIC HEALTH CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 YORK RD STORE FRONT
WILLOW GROVE PA
19090-2621
US

IV. Provider business mailing address

359 YORK RD STORE FRONT
WILLOW GROVE PA
19090-2621
US

V. Phone/Fax

Practice location:
  • Phone: 215-366-7141
  • Fax: 215-933-3120
Mailing address:
  • Phone: 215-366-7141
  • Fax: 215-933-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD422681
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD442471
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD422681
License Number StatePA

VIII. Authorized Official

Name: MS. AMANDA L RICCA
Title or Position: MANAGER
Credential:
Phone: 215-651-8180