Healthcare Provider Details

I. General information

NPI: 1548785801
Provider Name (Legal Business Name): BMAX PENNSYLVANIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 VAN REED RD
WYOMISSING PA
19610-1799
US

IV. Provider business mailing address

560 VAN REED RD
WYOMISSING PA
19610-1799
US

V. Phone/Fax

Practice location:
  • Phone: 484-516-2937
  • Fax: 484-930-0229
Mailing address:
  • Phone: 484-516-2937
  • Fax: 484-930-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY C BOLTON JR.
Title or Position: MD/OWNER
Credential: MD
Phone: 484-516-2937