Provider Demographics
NPI:1093744856
Name:MEDICA CENTER OF RICHBORO, P.C.
Entity Type:Organization
Organization Name:MEDICA CENTER OF RICHBORO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-942-2850
Mailing Address - Street 1:778 2ND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1003
Mailing Address - Country:US
Mailing Address - Phone:215-942-2850
Mailing Address - Fax:215-942-2854
Practice Address - Street 1:778 2ND STREET PIKE
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1003
Practice Address - Country:US
Practice Address - Phone:215-942-2850
Practice Address - Fax:215-942-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002905L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006162820007Medicaid
PA0006162820007Medicaid