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General NPI Number Information
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NPI Number | 1912062027
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Entity Type | Organization
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Legal Business Name | JEDWARD PCKERING,FACC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 100 E LANCASTER AVE SUITE 316 LANKENAU MED BLDG
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3450
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Country | US
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Telephone | 610-642-0100
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Fax | 610-642-0919
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Provider Business Mailing Address
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Address Line | 100 E LANCASTER AVE 316 LANKENAU MED BLDG
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3450
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Country | US
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Telephone | 610-642-0100
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Fax | 610-642-0919
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Authorized Official
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Title or Position | OWNER
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Name | JACK PICKERING
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Credential | M.D.
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Telephone | 610-642-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 007173E
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License Number State | PA
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