Organization
EASTERN PENNSYLVANIA PHYSICIAN SERVICES LLC
Active
Parent organization
VAXCARE CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
VAXCARE CORPORATION
Authorized official
CASEY DELOACH (MANAGER)
(888) 829-8550
Entity
Organization
Contact information
Practice address
160 W GERMANTOWN PIKE, STE D, EAST NORRITON, PA 19401-1386
(888) 829-8550
(855) 418-9149
Mailing address
3113 LAWTON RD, STE 250, ORLANDO, FL 32803-3531
(888) 829-8550
(855) 418-9149
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OS003411L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHC059
MEDICARE PTAN
—
Enumeration date
01/15/2015
Last updated
01/15/2015
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