MEDICARE: MEADOWLOFT, LLC

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

General Provider Information

NPI Number	:	1164639357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEADOWLOFT, LLC

Provider Business Mailing Address
First Line	:	19 ANTHONYS MILL RD
Second Line	:
City	:	BARTO
State	:	PA
Zip	:	19504-8811
Country	:	US
Telephone Number	:	610-845-8400
Fax Number	:	610-845-8426

Provider Business Practice Location Address
First Line	:	19 ANTHONYS MILL RD
Second Line	:
City	:	BARTO
State	:	PA
Zip	:	19504-8811
Country	:	US
Telephone Number	:	610-845-8400
Fax Number	:	610-845-8426

Authorized Official
Title or Position	:	CEO
Name	:	WOLFGANG WILLIAM SHAY
Credential	:	DO
Telephone Number	:	610-845-8400

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/16/2007

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Directions to “MEADOWLOFT, LLC ” Practice Location

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