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General NPI Number Information
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NPI Number | 1720425929
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Entity Type | Organization
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Legal Business Name | ATLANTIC HEALTH CARE PLLC
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 359 YORK RD STORE FRONT
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City | WILLOW GROVE
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State | PA
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Zip | 19090-2621
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Country | US
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Telephone | 215-366-7141
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Fax | 215-933-3120
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Provider Business Mailing Address
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Address Line | 359 YORK RD STORE FRONT
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City | WILLOW GROVE
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State | PA
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Zip | 19090-2621
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Country | US
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Telephone | 215-366-7141
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Fax | 215-933-3120
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Authorized Official
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Title or Position | MANAGER
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Name | MS. AMANDA L RICCA
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Credential |
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Telephone | 215-651-8180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD422681
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD442471
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | MD422681
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License Number State | PA
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