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General NPI Number Information
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NPI Number | 1336445592
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Entity Type | Organization
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Legal Business Name | BRYN MAWR PRIMARY CARE LLC
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 735 OLD LANCASTER RD
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City | BRYN MAWR
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State | PA
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Zip | 19010-3414
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Country | US
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Telephone | 610-520-1127
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Fax | 610-520-1143
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Provider Business Mailing Address
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Address Line | 735 OLD LANCASTER RD
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City | BRYN MAWR
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State | PA
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Zip | 19010-3414
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Country | US
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Telephone | 610-520-1127
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Fax | 610-520-1143
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Authorized Official
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Title or Position | OWNER
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Name | WINIFRED A. CONSTABLE
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Credential | MD
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Telephone | 610-520-1127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | PA
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