Provider Demographics
NPI:1144200023
Name:WOODBOURNE FAMILY PRACTICE, L.L.C.
Entity Type:Organization
Organization Name:WOODBOURNE FAMILY PRACTICE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOLDHAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-945-1500
Mailing Address - Street 1:1609 WOODBOURNE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1500
Mailing Address - Country:US
Mailing Address - Phone:215-945-1500
Mailing Address - Fax:215-945-9192
Practice Address - Street 1:1609 WOODBOURNE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1500
Practice Address - Country:US
Practice Address - Phone:215-945-1500
Practice Address - Fax:215-945-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA118864300OtherU.S. DEPARTMENT OF LABOR
PA1509982OtherUMWA
PACI1444OtherMEDICARE TRAVELERS
PA0017214600002Medicaid
PA0036OtherAETNA USHC HMO
PA1026402OtherKEYSTONE MERCY
PA0263375002OtherCIGNA
PACI1444OtherMEDICARE TRAVELERS
PA=========OtherEIN