Basic Information
| Provider Information | |||||||||
| NPI: | 1699053504 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELAWARE VALLEY BRAIN AND SPINE CARE,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1203 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | ST CLARE MEDICAL BUILDING SUITE 138 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1215741314 | ||||||||
| FaxNumber: | 2157413143 | ||||||||
| Practice Location | |||||||||
| Address1: | 1203 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | ST CLARE MEDICAL BUILDING SUITE 138 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157413141 | ||||||||
| FaxNumber: | 2157413143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2011 | ||||||||
| LastUpdateDate: | 12/02/2016 | ||||||||
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| AuthorizedOfficialLastName: | MCLAUGHLIN | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2157413141 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PRINCETON BRAIN & SPINE, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | MD426351 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD438119 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD447907 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD435536 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208VP0014X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207T00000X | MD053757 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.