{
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"EIN": null,
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"FirstLineMailingAddress": "11 INDUSTRIAL BLVD",
"SecondLineMailingAddress": "SUITE 103",
"MailingAddressCityName": "PAOLI",
"MailingAddressStateName": "PA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "610-786-3200",
"MailingAddressFaxNumber": "610-786-3208",
"FirstLinePracticeLocationAddress": "11 INDUSTRIAL BLVD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-786-3200",
"PracticeLocationAddressFaxNumber": "610-786-3208",
"EnumerationDate": "07/30/2006",
"LastUpdateDate": "09/19/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "OS010701L",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}