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General NPI Number Information
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NPI Number | 1356454706
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Entity Type | Organization
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Legal Business Name | CHESTER FAMILY PRACTICE
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 521 E 9TH ST
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City | CHESTER
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State | PA
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Zip | 19013-6136
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Country | US
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Telephone | 610-872-0565
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Fax | 610-872-4478
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Provider Business Mailing Address
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Address Line | 521 E 9TH ST
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City | CHESTER
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State | PA
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Zip | 19013-6136
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Country | US
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Telephone | 610-872-0565
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Fax | 610-872-4478
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARYLYN ANN MUDRICK
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Credential | MD
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Telephone | 610-872-0565
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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 | MD029229E
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License Number State | PA
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