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General NPI Number Information
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NPI Number | 1750449468
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Entity Type | Organization
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Legal Business Name | RISING SUN FAMILY PRACTICE CENTER, INC.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 7131 RISING SUN AVE
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City | PHILADEPHIA
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State | PA
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Zip | 19111-3924
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Country | US
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Telephone | 215-742-9700
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Fax | 215-742-0828
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Provider Business Mailing Address
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Address Line | 7131 RISING SUN AVE
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City | PHILADEPHIA
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State | PA
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Zip | 19111-3924
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Country | US
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Telephone | 215-742-9700
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Fax | 215-742-0828
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Authorized Official
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Title or Position | PRESIDENT PHYSICIAN
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Name | ANDREW SCOTT POULSHOCK
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Credential | DO
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Telephone | 215-742-9700
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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 |
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License Number State |
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