Organization
CHESTER FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARYLYN ANN MUDRICK MD (OWNER)
(610) 872-0565
Entity
Organization
Contact information
Practice address
521 E 9TH ST, CHESTER, PA 19013-6136
(610) 872-0565
(610) 872-4478
Mailing address
521 E 9TH ST, CHESTER, PA 19013-6136
(610) 872-0565
(610) 872-4478
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD029229E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0554265001
—
PA
01
—
5023294
BLUE SHIELD
PA
Enumeration date
08/17/2006
Last updated
05/02/2008
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