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General NPI Number Information
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NPI Number | 1720057474
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Entity Type | Organization
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Legal Business Name | IVYLAND MEDICAL CENTER
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 1035 W BRISTOL RD SUITE B
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City | WARMINSTER
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State | PA
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Zip | 18974-1009
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Country | US
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Telephone | 215-442-9929
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Fax | 215-442-9927
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Provider Business Mailing Address
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Address Line | 1035 W BRISTOL RD SUITE B
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City | WARMINSTER
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State | PA
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Zip | 18974-1009
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Country | US
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Telephone | 215-442-9929
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Fax | 215-442-9927
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRAD PADDOCK
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Credential | MD
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Telephone | 215-442-9929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD071701L
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License Number State | PA
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