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General NPI Number Information
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NPI Number | 1093270019
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S PHYSICIAN GROUP INC.
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 7001 N ROUTE 309
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City | COOPERSBURG
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State | PA
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Zip | 18036-1109
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Country | US
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Telephone | 484-526-4999
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Fax |
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Provider Business Mailing Address
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Address Line | 7001 N ROUTE 309
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City | COOPERSBURG
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State | PA
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Zip | 18036-1109
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Country | US
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Telephone | 484-526-4999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEAN EVANS
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Credential |
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Telephone | 484-526-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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