=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205898996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MACUNGIE MEDICAL GROUP PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2006
-----------------------------------------------------
Last Update Date | 01/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3760 BROOKSIDE RD
-----------------------------------------------------
City | MACUNGIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18062-1741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-966-4646
-----------------------------------------------------
Fax | 610-965-6201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3760 BROOKSIDE RD
-----------------------------------------------------
City | MACUNGIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18062-1741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-966-4646
-----------------------------------------------------
Fax | 610-965-6201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. HAL SCOTT BENDIT
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 610-966-4646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------