Basic Information
| Provider Information | |||||||||
| NPI: | 1659770964 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHCGPA CENTER FOR BREAST HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1109 | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OAKS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194561109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104824778 | ||||||||
| FaxNumber: | 6106663310 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 INDUSTRIAL BLVD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | PAOLI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193011605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109941136 | ||||||||
| FaxNumber: | 2156874775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2014 | ||||||||
| LastUpdateDate: | 08/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | BICKEL | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4848310200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WOMENS HEALTH CARE GROUP OF PENNSYLVANIA LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.