=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679626642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUCKS PHILADELPHIA MEDICAL CARE GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2007
-----------------------------------------------------
Last Update Date | 08/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1718 WELSH ROAD
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19115-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-947-6143
-----------------------------------------------------
Fax | 215-947-6274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 LISA CIR
-----------------------------------------------------
City | HUNTINGDON VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19006-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-947-6143
-----------------------------------------------------
Fax | 215-947-6274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANDREW MARK BERKOWITZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 215-947-6143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD036462E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------