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Individual

MARY N ROY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
255 W LANCASTER AVE, PAOLI, PA 19301-1763
(610) 648-1000
Mailing address
255 W LANCASTER AVE, PAOLI, PA 19301-1763
(610) 648-1000

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD038157E
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0012940760005
PA
01
0129407604
AMERICHOICE
PA
01
0459431000
KEYSTONE HEALTHPLAN EAST
PA
01
629588
BLUE SHIELD PA
PA
Enumeration date
10/24/2006
Last updated
09/02/2011
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