Organization
THOMAS C DETWEILER,MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VALERIE M HAYNES (OFFICE MANAGER)
(215) 822-6333
Entity
Organization
Contact information
Practice address
2405 N BROAD ST, COLMAR, PA 18915-9406
(215) 822-6333
(215) 822-1891
Mailing address
2405 N BROAD ST, COLMAR, PA 18915-9406
(215) 822-6333
(215) 822-1891
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
MD039504L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659310704
INDEPENDENCE BLUE CROSS
PA
Enumeration date
10/04/2013
Last updated
10/04/2013
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