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General NPI Number Information
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NPI Number | 1417772617
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Entity Type | Organization
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Legal Business Name | CORE FAMILY PRACTICE
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 413 W CYPRESS ST
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-3071
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Country | US
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Telephone | 610-612-9283
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Fax | 610-320-2009
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Provider Business Mailing Address
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Address Line | 413 W CYPRESS ST
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-3071
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Country | US
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Telephone | 610-612-9283
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Fax | 610-320-2009
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Authorized Official
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Title or Position | OWNER/CEO
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Name | RICHARD PATRICK HAUG
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Credential | MD
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Telephone | 610-612-9283
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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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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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