Provider Demographics
NPI:1326341561
Name:HOMETOWN INTERNAL MEDICINE
Entity Type:Organization
Organization Name:HOMETOWN INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:MADEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-770-9569
Mailing Address - Street 1:2905 EDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5409
Mailing Address - Country:US
Mailing Address - Phone:610-770-9569
Mailing Address - Fax:610-770-9569
Practice Address - Street 1:2905 EDGEMONT DR
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5409
Practice Address - Country:US
Practice Address - Phone:610-770-9569
Practice Address - Fax:610-770-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072392L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty