Basic Information
| Provider Information | |||||||||
| NPI: | 1831266477 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF PENNSYLVANIA, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BUCKS COUNTY KIDNEY SPECIALIST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1627 COLE BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804013315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036266239 | ||||||||
| FaxNumber: | 8669175396 | ||||||||
| Practice Location | |||||||||
| Address1: | 1627 COLE BLVD BLDG 18 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804013315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036266239 | ||||||||
| FaxNumber: | 8669175396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 11/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | GABRIEL | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | EFTHIM | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3105362597 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.