Provider Demographics
NPI:1093771420
Name:OXFORD VALLEY MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:OXFORD VALLEY MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-262-5736
Mailing Address - Street 1:320 MIDDLETOWN BLVD STE 301
Mailing Address - Street 2:PO BOX 908
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-3202
Mailing Address - Country:US
Mailing Address - Phone:267-568-2042
Mailing Address - Fax:267-568-2089
Practice Address - Street 1:320 MIDDLETOWN BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3202
Practice Address - Country:US
Practice Address - Phone:267-568-2042
Practice Address - Fax:267-568-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005896L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038470520001Medicaid