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General NPI Number Information
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NPI Number | 1053559021
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Entity Type | Organization
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Legal Business Name | MAIN LINE FAMILY PRACTICE
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Dates
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Enumeration Date | 01/29/2009
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Last Update Date | 01/29/2009
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Provider Practice Location Address
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Address Line | 888 GLENBROOK AVE
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City | BRYN MAWR
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State | PA
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Zip | 19010-2506
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Country | US
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Telephone | 610-525-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 227 WINSOR LN
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City | HAVERFORD
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State | PA
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Zip | 19041-1822
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Country | US
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Telephone | 610-642-7741
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. CLAUDIA LIANE HARGROVE
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Credential | MD
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Telephone | 484-995-7741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD 430289
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License Number State | PA
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