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General NPI Number Information
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NPI Number | 1831104405
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Entity Type | Organization
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Legal Business Name | MT AIRY FAMILY PRACTICE
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 760 CARPENTER LN
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City | PHILADELPHIA
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State | PA
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Zip | 19119-3406
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Country | US
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Telephone | 215-848-6880
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Fax | 215-848-3333
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Provider Business Mailing Address
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Address Line | 760 CARPENTER LN
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City | PHILADELPHIA
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State | PA
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Zip | 19119-3406
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Country | US
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Telephone | 215-848-6880
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Fax | 215-848-3333
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. THOMAS LYON
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Credential | MD
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Telephone | 215-848-6880
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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 | MD041004E
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License Number State | PA
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