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Organization
MOBILE MEDICAL PRACTITIONERS
Active
Organization
MOBILE MEDICAL PRACTITIONERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LANCE K JOHNSON (OWNER)
(215) 701-8153
Entity
Organization
Contact information
Practice address
111 PRESIDENTIAL BLVD STE 165, BALA CYNWYD, PA 19004-1005
(215) 701-8153
Mailing address
111 PRESIDENTIAL BLVD STE 165, BALA CYNWYD, PA 19004-1005
(215) 701-8153
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA053291
PA
Other
Enumeration date
01/06/2014
Last updated
01/06/2014
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