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General NPI Number Information
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NPI Number | 1215232038
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Entity Type | Organization
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Legal Business Name | INNOVATIVE DIAGNOSTIC SOLUTIONS LLC
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 587 WATERLOO CIR
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City | BERWYN
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State | PA
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Zip | 19312-3701
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Country | US
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Telephone | 610-608-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 587 WATERLOO CIR
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City | BERWYN
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State | PA
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Zip | 19312-3701
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Country | US
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Telephone | 610-608-8787
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN DIRECTOR
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Name | DR. NEAL SKOP
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Credential | MD
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Telephone | 610-608-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD063627L
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License Number State | PA
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