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General NPI Number Information
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NPI Number | 1659390698
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Entity Type | Organization
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Legal Business Name | COLON & RECTAL SURGERY, LTD.
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 1088 W BALTIMORE PIKE SUITE 2101
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City | MEDIA
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State | PA
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Zip | 19063-5136
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Country | US
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Telephone | 610-565-3435
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Fax | 610-566-1387
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Provider Business Mailing Address
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Address Line | 1088 W BALTIMORE PIKE SUITE 2101
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City | MEDIA
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State | PA
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Zip | 19063-5136
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Country | US
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Telephone | 610-565-3435
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Fax | 610-566-1387
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH J BOYD
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Credential | M.D.
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Telephone | 610-565-3435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State |
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