MEDICARE: LOSE WEIGHT 1 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	:	1851644942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOSE WEIGHT 1 LLC

Provider Business Mailing Address
First Line	:	901 LANCASTER AVE
Second Line	:	SUITE 100
City	:	BERWYN
State	:	PA
Zip	:	19312-1710
Country	:	US
Telephone Number	:	610-251-2525
Fax Number	:	610-251-2599

Provider Business Practice Location Address
First Line	:	901 LANCASTER AVE
Second Line	:	SUITE 100
City	:	BERWYN
State	:	PA
Zip	:	19312-1710
Country	:	US
Telephone Number	:	610-251-2525
Fax Number	:	610-251-2599

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. STEPHEN PAUL KRELL
Credential	:	M.D.
Telephone Number	:	610-251-2525

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	06/03/2016

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Directions to “LOSE WEIGHT 1 LLC ” Practice Location

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