Provider Demographics
NPI:1164407680
Name:CHESTER COUNTY FAMILY MEDICINE
Entity Type:Organization
Organization Name:CHESTER COUNTY FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANSHUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:GAMBHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-280-9994
Mailing Address - Street 1:234 N POTTSTOWN PIKE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2213
Mailing Address - Country:US
Mailing Address - Phone:610-280-9994
Mailing Address - Fax:215-243-6094
Practice Address - Street 1:234 N POTTSTOWN PIKE
Practice Address - Street 2:SUITE A-1
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2213
Practice Address - Country:US
Practice Address - Phone:610-280-9994
Practice Address - Fax:215-243-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071568L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001853020 0001Medicaid
PAH32874Medicare UPIN
PA001853020 0001Medicaid