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General NPI Number Information
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NPI Number | 1245736446
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Entity Type | Organization
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Legal Business Name | MODERN FAMILY MEDICINE MAIN LINE LLC
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 864 COUNTY LINE RD
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City | BRYN MAWR
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State | PA
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Zip | 19010-2516
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Country | US
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Telephone | 484-222-6222
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Fax |
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Provider Business Mailing Address
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Address Line | 864 COUNTY LINE RD
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City | BRYN MAWR
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State | PA
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Zip | 19010-2516
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Country | US
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Telephone | 484-222-6222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID HO
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Credential | MD
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Telephone | 484-222-6222
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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 |
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