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General NPI Number Information
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NPI Number | 1831219815
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Entity Type | Organization
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Legal Business Name | A. WAYNE TRONCELLITI, M.D., LLC
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Dates
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Enumeration Date | 03/31/2007
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Last Update Date | 12/03/2012
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Provider Practice Location Address
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Address Line | 1522 WYNNEWOOD RD
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City | ARDMORE
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State | PA
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Zip | 19003-2719
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Country | US
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Telephone | 610-642-0650
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Fax | 610-642-5118
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Provider Business Mailing Address
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Address Line | 1522 WYNNEWOOD RD
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City | ARDMORE
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State | PA
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Zip | 19003-2719
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Country | US
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Telephone | 610-642-0650
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Fax | 610-642-5118
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Authorized Official
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Title or Position | OWNER
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Name | ALFRED WAYNE TRONCELLITI
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Credential | M.D.
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Telephone | 610-642-0650
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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 | MD035270L
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License Number State | PA
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