Full Name | |
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Type | Facility |
Speciality | Family Medicine |
Location | 4103 Main St, Elverson, Pennsylvania |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1710958475 | NPI | - | NPPES |
1310236 | Other | PA | PA BLUE SHIELD |
DG2978 | Other | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | (* (Not Available)) | Secondary |
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
208000000X | Pediatrics | (* (Not Available)) | Secondary |
Provider Name | Gordon R Donaldson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1942295027 PECOS PAC ID: 1254309388 Enrollment ID: I20040920000021 |
Provider Name | Timothy L Tam |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1598769580 PECOS PAC ID: 5597709196 Enrollment ID: I20050615000022 |
Mailing Address | Practice Location Address |
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Po Box 488, Morgantown, PA 19543 Ph: (610) 286-9064 | 4103 Main St, Elverson, PA 19520 Ph: (610) 286-9064 |