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General NPI Number Information
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NPI Number | 1699715086
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Entity Type | Organization
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Legal Business Name | BOOTHWYN MEDICAL ASSOCIATES P.C.
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/12/2011
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Provider Practice Location Address
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Address Line | 1440 CONCHESTER HWY SUITE 5A
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City | BOOTHWYN
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State | PA
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Zip | 19061-2124
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Country | US
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Telephone | 610-459-3722
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Fax | 610-459-4730
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Provider Business Mailing Address
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Address Line | 1440 CONCHESTER HWY SUITE 5A
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City | BOOTHWYN
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State | PA
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Zip | 19061-2124
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Country | US
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Telephone | 610-459-3722
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Fax | 610-459-4730
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | DR. RODNEY M. ELKIN
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Credential | M.D.
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Telephone | 610-459-3722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | MD038926L
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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 | MD030635E
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License Number State | PA
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