Individual
LAWRENCE DECKELBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
911 MERION SQUARE RD, GLADWYNE, PA 19035-1509
(610) 649-6422
Mailing address
911 MERION SQUARE RD, GLADWYNE, PA 19035-1509
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD-057112-L
PA
Other
Enumeration date
12/10/2009
Last updated
12/10/2009
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