=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528398153
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN KEEGAN DEVINE D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2010
-----------------------------------------------------
Last Update Date | 11/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E LANCASTER AVE LANKENAU MEDICAL CENTER, MOB-EAST, SUITE 158
-----------------------------------------------------
City | WYNNEWOOD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19096-3450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-649-2126
-----------------------------------------------------
Fax | 610-642-7814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 E LANCASTER AVE LANKENAU MEDICAL CENTER, MOB-EAST, SUITE 158
-----------------------------------------------------
City | WYNNEWOOD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19096-3450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-649-2126
-----------------------------------------------------
Fax | 610-642-7814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | OSO14347
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | FD3534927
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------