Basic Information
| Provider Information | |||||||||
| NPI: | 1154894236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POTTSTOWN MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 MEDICAL DR | ||||||||
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| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194643241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103274200 | ||||||||
| FaxNumber: | 6103278160 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 E HIGH ST | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194645677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103271785 | ||||||||
| FaxNumber: | 6103271414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2019 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | KOLBMANN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6103274200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.