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General NPI Number Information
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NPI Number | 1699726844
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Entity Type | Organization
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Legal Business Name | NAZARETH PHYSICIAN SERVICES INC
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 2701 HOLME AVE SUITE 205
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2029
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Country | US
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Telephone | 215-543-1026
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Fax | 215-338-1250
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Provider Business Mailing Address
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Address Line | 1 W ELM ST SUITE 100
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-2007
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Country | US
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Telephone | 610-567-6967
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Fax | 610-567-6170
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Authorized Official
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Title or Position | SIR DIR PHYSICIAN BILLING
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Name | LANCE CASTLE
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Credential |
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Telephone | 610-567-5520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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