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General NPI Number Information
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NPI Number | 1063649283
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Entity Type | Organization
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Legal Business Name | ESBENSHADE MEDICAL CARE PC
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 2615 CRABAPPLE CIR
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City | PERKASIE
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State | PA
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Zip | 18944-5460
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Country | US
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Telephone | 215-703-3751
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Fax | 215-703-3744
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Provider Business Mailing Address
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Address Line | 2615 CRABAPPLE CIR
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City | PERKASIE
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State | PA
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Zip | 18944-5460
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Country | US
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Telephone | 215-703-3751
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Fax | 215-703-3744
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Authorized Official
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Title or Position | MEDICAL BILLER
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Name | SUSAN SLACK
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Credential |
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Telephone | 215-348-2335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | MD069937L
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License Number State | PA
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