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Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
470 SENTRY PKWY E, STE 200, BLUE BELL, PA 19422-2324
(610) 825-5800
(610) 397-0980
Mailing address
9800 SHELBYVILLE RD, STE 220, LOUISVILLE, KY 40223-2992
(502) 429-8585
(855) 656-7325

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
MD041379L
PA

Other

Enumeration date
05/23/2005
Last updated
03/28/2022
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