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Organization
HAVERFORD FAMILY MEDICINE
Active
Organization
HAVERFORD FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN W BULLOCK (PRESIDENT)
(610) 649-6400
Entity
Organization
Contact information
Practice address
600 HAVERFORD RD, SUITE 205, HAVERFORD, PA 19041-1139
(610) 649-6400
Mailing address
600 HAVERFORD RD, SUITE 205, HAVERFORD, PA 19041-1139
(610) 649-6400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD040154L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1209404
—
PA
Enumeration date
09/26/2006
Last updated
06/29/2010
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