Provider Demographics
NPI:1225137284
Name:TICK BORNE DISEASE CENTER OF SEPA
Entity Type:Organization
Organization Name:TICK BORNE DISEASE CENTER OF SEPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-459-5920
Mailing Address - Street 1:6 DICKINSON DR
Mailing Address - Street 2:BLDG 300 STE 4
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9689
Mailing Address - Country:US
Mailing Address - Phone:610-459-5920
Mailing Address - Fax:610-459-5960
Practice Address - Street 1:6 DICKINSON DR
Practice Address - Street 2:BLDG 300 STE 4
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9689
Practice Address - Country:US
Practice Address - Phone:610-459-5920
Practice Address - Fax:610-459-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD48953Medicare UPIN
PA072946Medicare PIN