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General NPI Number Information
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NPI Number | 1205880069
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Entity Type | Organization
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Legal Business Name | WYOMISSING FAMILY MEDICAL ASSOC LLC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1075 BERKSHIRE BLVD STE 950
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City | WYOMISSING
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State | PA
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Zip | 19610
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Country | US
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Telephone | 610-375-8225
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Fax | 610-375-1883
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Provider Business Mailing Address
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Address Line | 1075 BERKSHIRE BLVD STE 950
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City | WYOMISSING
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State | PA
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Zip | 19610
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Country | US
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Telephone | 610-375-8225
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Fax | 610-375-1883
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN J TRAVERS
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Credential | MD
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Telephone | 610-375-8225
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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 |
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License Number State | PA
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