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General NPI Number Information
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NPI Number | 1467619452
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Entity Type | Organization
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Legal Business Name | COUNTY OF MONTGOMERY HOUSE STAFF
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 1600 BLACK ROCK RD
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City | ROYERSFORD
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State | PA
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Zip | 19468-3147
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Country | US
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Telephone | 610-792-2224
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 BLACK ROCK RD
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City | ROYERSFORD
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State | PA
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Zip | 19468-3147
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Country | US
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Telephone | 610-792-2224
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MELANIE DEBLASE
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Credential | DON
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Telephone | 610-792-2224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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