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General NPI Number Information
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NPI Number | 1861693673
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Entity Type | Organization
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Legal Business Name | INSTITUTIONAL PSYCHIATRIC CONSULTATION SERVICES
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 414 PAOLI PIKE
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City | MALVERN
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State | PA
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Zip | 19355
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Country | US
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Telephone | 610-651-0657
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Fax | 610-722-0704
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Provider Business Mailing Address
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Address Line | 414 PAOLI PINE
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City | MALVERN
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State | PA
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Zip | 19355-3311
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Country | US
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Telephone | 610-324-4930
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Fax | 610-722-0704
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Authorized Official
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Title or Position | CHAIRMAN OWNER
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Name | DALE PANZER
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Credential | MD
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Telephone | 610-324-4930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD050187-L
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License Number State | PA
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