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23 Bustleton Avenue Suite 200 Feasterville PA 19053 | |
(215) 464-0770 | |
(267) 579-0720 |
Full Name | |
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Speciality | Internal Medicine |
Location | 23 Bustleton Avenue, Feasterville, Pennsylvania |
Authorized Official Name and Position | Russell R. Wagner (EXECUTIVE VICE PRESIDENT, FINANCE) |
Authorized Official Contact | 2158561114 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 8500 Box #4081 Philadelphia PA 19178-4081 Ph: (215) 856-1010 | 23 Bustleton Avenue Suite 200 Feasterville PA 19053 Ph: (215) 464-0770 |
NPI Number | 1275533655 |
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Provider Enumeration Date | 07/27/2005 |
Last Update Date | 12/14/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275533655 | NPI | - | NPPES |
001531340030 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Thomas Duffield, Md, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1200 Bustleton Pike, Suite 9, Feasterville, PA 19053 Phone: 267-225-2975 Fax: 866-973-9701 | |