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General NPI Number Information
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NPI Number | 1780742841
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Entity Type | Organization
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Legal Business Name | MAIN LINE INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 11 INDUSTRIAL BLVD SUITE 101
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City | PAOLI
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State | PA
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Zip | 19301-1632
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Country | US
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Telephone | 610-695-9878
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Fax |
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Provider Business Mailing Address
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Address Line | 11 INDUSTRIAL BLVD SUITE 101
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City | PAOLI
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State | PA
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Zip | 19301-1632
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Country | US
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Telephone | 610-695-9878
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ELANA KRIPKE
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Credential | MD
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Telephone | 610-695-9878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD046844L
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License Number State | PA
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