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Organization
MEDICAL CENTER OF BUSTLETON PC
Active
Organization
MEDICAL CENTER OF BUSTLETON PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA MARIE GAVARONE DO (PRESIDENT OWNER)
(215) 673-7067
Entity
Organization
Contact information
Practice address
9622 BUSTLETON AVENUE, SUITE 6, PHILADELPHIA, PA 19115-3100
(215) 673-7067
(215) 673-4966
Mailing address
9622 BUSTLETON AVENUE, SUITE 6, PHILADELPHIA, PA 19115-3100
(215) 673-7067
(215) 673-4966
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015772220005
—
PA
Enumeration date
10/25/2006
Last updated
06/29/2010
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