Provider Demographics
NPI:1033508742
Name:ROXBOROUGH MEDICAL NETWORK LLC
Entity Type:Organization
Organization Name:ROXBOROUGH MEDICAL NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FENSTERMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-366-4606
Mailing Address - Street 1:5735 RIDGE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1745
Mailing Address - Country:US
Mailing Address - Phone:570-366-4606
Mailing Address - Fax:570-366-5032
Practice Address - Street 1:5735 RIDGE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1745
Practice Address - Country:US
Practice Address - Phone:570-366-4606
Practice Address - Fax:570-366-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty