=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740334812
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT SQUARE FAMILY MEDICINE,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 04/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1709 LANGHORNE NEWTOWN RD
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-986-1900
-----------------------------------------------------
Fax | 215-968-1097
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1709 LANGHORNE NEWTOWN RD
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-986-1900
-----------------------------------------------------
Fax | 215-968-1097
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LOUIS DAVID BIERMAN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 215-968-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0S003880L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------