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General NPI Number Information
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NPI Number | 1578607305
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Entity Type | Organization
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Legal Business Name | CARRIAGE HOUSE MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 1811 BETHLEHEM PIKE STE B211
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City | FLOURTOWN
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State | PA
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Zip | 19031-1111
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Country | US
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Telephone | 267-419-8189
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 BETHLEHEM PIKE STE B211
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City | FLOURTOWN
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State | PA
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Zip | 19031-1111
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Country | US
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Telephone | 267-419-8189
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. EMMANUEL CHUKWUDI OKOLO
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Credential | MD
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Telephone | 267-419-8189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD426910
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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