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General NPI Number Information
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NPI Number | 1790636876
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Entity Type | Organization
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Legal Business Name | 1977 MESK
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Dates
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Enumeration Date | 02/05/2026
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 605 LOUIS DR
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City | WARMINSTER
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State | PA
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Zip | 18974-2830
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Country | US
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Telephone | 610-744-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 605 LOUIS DR
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City | WARMINSTER
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State | PA
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Zip | 18974-2830
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ILONA OSADZE
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Credential | FNP-C
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Telephone | 610-744-1919
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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 |
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License Number State |
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Taxonomy #2
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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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