MEDICARE: ST. LAWRENCE MEDICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		PA
2	207R00000X	Internal Medicine Physician		PA

General Provider Information

NPI Number	:	1124024138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LAWRENCE MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	120 PROSPECT ST
Second Line	:
City	:	READING
State	:	PA
Zip	:	19606-2871
Country	:	US
Telephone Number	:	610-779-1330
Fax Number	:	610-779-7699

Provider Business Practice Location Address
First Line	:	120 PROSPECT ST
Second Line	:
City	:	READING
State	:	PA
Zip	:	19606-2871
Country	:	US
Telephone Number	:	610-779-1330
Fax Number	:	610-779-7699

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. PATRICIA A. MCGARVEY
Credential	:
Telephone Number	:	610-779-1330

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/21/2022

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