Individual
MFON PIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
2250 HICKORY RD, SUITE 240, PLYMOUTH MEETING, PA 19462-1047
(610) 834-1122
Mailing address
5656 LEIDEN RD, BALTIMORE, MD 21206-2913
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP29818
MD
Other
Enumeration date
06/26/2007
Last updated
07/08/2007
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