=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821257684
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXTON ALLERGY & ASTHMA ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2008
-----------------------------------------------------
Last Update Date | 10/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 656 WEST LINCOLN HWY
-----------------------------------------------------
City | EXTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-269-3066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 MORGAN DALE CT
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19543-8849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-913-1303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANGELA DURSO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 610-913-1303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | MD057762L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------