MEDICARE: FAMILY PRACTICE OF HONEY BROOK, PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0026510001	OTHER	PA	KEYSTONE GROUP #

General Provider Information

NPI Number	:	1588640379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRACTICE OF HONEY BROOK, PC

Provider Business Mailing Address
First Line	:	PO BOX 460
Second Line	:	471 PEQUEA AVE
City	:	HONEY BROOK
State	:	PA
Zip	:	19344-0460
Country	:	US
Telephone Number	:	610-273-2429
Fax Number	:	610-273-3798

Provider Business Practice Location Address
First Line	:	471 PEQUEA AVE
Second Line	:
City	:	HONEY BROOK
State	:	PA
Zip	:	19344
Country	:	US
Telephone Number	:	610-273-2429
Fax Number	:	610-273-3798

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	ELIZABETH J CARROLL
Credential	:	D.O.
Telephone Number	:	610-273-2429

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	10/26/2009

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