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General NPI Number Information
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NPI Number | 1518417096
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Entity Type | Organization
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Legal Business Name | LOWER BUCKS PEDIATRICS
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 3400 RED LION RD APT 41A
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1348
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Country | US
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Telephone | 267-250-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 RED LION RD APT 41A
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1348
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC NURSE PRACTITIONER
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Name | MARGARET RIES
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Credential | CRNP
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Telephone | 267-250-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | SP016583
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License Number State | PA
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