=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821030321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALORIE L. BUDMAN D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2006
-----------------------------------------------------
Last Update Date | 04/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 STERIGERE ST NORRISTOWN STATE HOSPITAL
-----------------------------------------------------
City | NORRISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19401-5300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-313-1000
-----------------------------------------------------
Fax | 610-313-1013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7956 VERREE RD
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19111-2530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-745-7101
-----------------------------------------------------
Fax | 215-745-0981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS 009602L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | OS009602L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------