MEDICARE: DOUGLAS L ATLAS MD

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	207R00000X	Internal Medicine Physician	MD071529L	PA

General Provider Information

NPI Number	:	1932168895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS L ATLAS MD

Provider Business Mailing Address
First Line	:	412 CREAMERY WAY
Second Line	:	SUITE 400
City	:	EXTON
State	:	PA
Zip	:	19341-2500
Country	:	US
Telephone Number	:	610-594-7590
Fax Number	:	610-594-2625

Provider Business Practice Location Address
First Line	:	520 MAPLE AVE
Second Line	:	SUITE 4
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4434
Country	:	US
Telephone Number	:	610-430-8200
Fax Number	:	610-594-2625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	10/05/2020

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