Provider Demographics
NPI:1346220084
Name:PRICE, DOUGLAS (PA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:994 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:STE 1017
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1802
Mailing Address - Country:US
Mailing Address - Phone:610-902-6092
Mailing Address - Fax:610-902-6081
Practice Address - Street 1:306 W LOGAN ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-2935
Practice Address - Country:US
Practice Address - Phone:610-275-6153
Practice Address - Fax:610-278-7709
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2016-07-28
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Provider Licenses
StateLicense IDTaxonomies
PAMA000742L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS22164Medicare UPIN