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General NPI Number Information
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NPI Number | 1972667756
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Entity Type | Organization
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Legal Business Name | SACRED HEART NEUROLOGY
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 450 W CHEW ST SUITE 204
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City | ALLENTOWN
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State | PA
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Zip | 18102-3434
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Country | US
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Telephone | 610-776-5491
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Fax | 610-606-4432
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Provider Business Mailing Address
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Address Line | 450 W CHEW ST SUITE 204
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City | ALLENTOWN
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State | PA
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Zip | 18102-3434
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Country | US
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Telephone | 610-776-5491
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Fax | 610-606-4432
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Authorized Official
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Title or Position | NEUROLOGIST
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Name | DR. HENRY DONALD WILLS
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Credential | M.D.
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Telephone | 610-776-5491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD018030E
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License Number State | PA
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