=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851630891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUBURBAN ALLERGY CONSULTANTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2013
-----------------------------------------------------
Last Update Date | 07/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 822 MONTGOMERY AVE STE 318
-----------------------------------------------------
City | NARBERTH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19072-1948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-270-8584
-----------------------------------------------------
Fax | 484-270-8584
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1065 ANDREW DR
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19380-4370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-270-8485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CORINNA SABINE BOWSER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 484-270-8584
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | MD428476
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------