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Organization
THE MODERN COUNTRY DOCTOR, LLC
Active
Organization
THE MODERN COUNTRY DOCTOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS FAITH MD (OWNER)
(610) 890-8522
Entity
Organization
Contact information
Practice address
23 INDUSTRIAL BLVD STE D, PAOLI, PA 19301-1601
(610) 890-8522
(484) 568-4748
Mailing address
23 INDUSTRIAL BLVD STE D, PAOLI, PA 19301-1601
(610) 890-8522
(484) 568-4748
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Enumeration date
05/15/2020
Last updated
05/15/2020
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