Organization
PMSI DIVISION OF NEPHROLOGY
Active
Other names
POTTSTOWN MEDICAL SPECIALISTS NEPHROLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA M ENOCHS (CREDENTIALING SPECIALIST)
(610) 327-4200
Entity
Organization
Contact information
Practice address
1591 MEDICAL DRIVE, POTTSTOWN, PA 19464
(610) 326-8005
(484) 945-0509
Mailing address
1610 MEDICAL DRIVE, SUITE 310, POTTSTOWN, PA 19464
(610) 327-4200
(610) 327-8160
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD438936
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007964850006
—
PA
01
—
0860002000
KEYSTONE HMO
PA
01
—
919349
PA BLUE SHIELD
PA
Enumeration date
03/20/2007
Last updated
07/14/2016
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