Organization
BROOKSIDE FAMILY PRACTICE & PEDIATRICS
Active
Parent organization
BROOKSIDE FAMILY PRACTICE & PEDIATRICS
Other names
BROOKSIDE FAMILY PRACTICE
Organization subpart
Yes
Provider details
NPI number
Legal business name
BROOKSIDE FAMILY PRACTICE & PEDIATRICS
Authorized official
SHANA M ENOCHS (CREDENTIALING SPECIALIST)
(610) 327-4200
Entity
Organization
Contact information
Practice address
1555 MEDICAL DRIVE, POTTSTOWN, PA 19464
(610) 326-7820
(610) 326-4068
Mailing address
1555 MEDICAL DRIVE, POTTSTOWN, PA 19464
(610) 326-7820
(610) 326-4068
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD027759E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0045725011
KEYSTONE HMO
PA
01
—
26191
BLUE SHIELD ASSIGN ACCT
PA
Enumeration date
03/20/2007
Last updated
07/14/2016
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