=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689624884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUHLENBERG PRIMARY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2649 SCHOENERSVILLE RD SUITE 201
-----------------------------------------------------
City | BETHLEHEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18017-7326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-868-6880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1650 VALLEY CENTER PKWY SUITE 100
-----------------------------------------------------
City | BETHLEHEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18017-2344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-884-4436
-----------------------------------------------------
Fax | 484-884-4444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GAVIN BARR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 610-868-6880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------