Basic Information
| Provider Information | |||||||||
| NPI: | 1811921166 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY PRACTICE ASSOCIATES OF UPPER DUBLIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1244 FORT WASHINGTON AVE | ||||||||
| Address2: | STE E2 | ||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156461686 | ||||||||
| FaxNumber: | 2156284956 | ||||||||
| Practice Location | |||||||||
| Address1: | 1244 FORT WASHINGTON AVE | ||||||||
| Address2: | STE E2 | ||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156461686 | ||||||||
| FaxNumber: | 2156284956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BADOLATO | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2156461686 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.