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General NPI Number Information
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NPI Number | 1477760684
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Entity Type | Organization
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Legal Business Name | ST MARY MEDICAL CENTER
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1201 LANGHORNE NEWTOWN RD MEDICAL STAFF OFFICE
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City | LANGHORNE
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State | PA
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Zip | 19047-1201
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Country | US
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Telephone | 215-710-5744
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Fax | 215-710-5052
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Provider Business Mailing Address
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Address Line | 1557 WILLOW POND DR
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City | YARDLEY
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State | PA
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Zip | 19067-5793
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Country | US
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Telephone | 215-493-9059
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Fax | 215-710-5052
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Authorized Official
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Title or Position | VP MEDICAL AFFAIRS
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Name | JOSEPH CONROY
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Credential | MD
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Telephone | 215-710-2009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | TP003582B
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License Number State | PA
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