Provider Demographics
NPI:1376505487
Name:WEST CORNWALL FAMILY PRACTICE, P.C.
Entity Type:Organization
Organization Name:WEST CORNWALL FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-279-7303
Mailing Address - Street 1:101 FAIRVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-9581
Mailing Address - Country:US
Mailing Address - Phone:717-279-7303
Mailing Address - Fax:717-279-7471
Practice Address - Street 1:101 FAIRVIEW CIR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-9581
Practice Address - Country:US
Practice Address - Phone:717-279-7303
Practice Address - Fax:717-279-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1583098OtherPA BLUE SHIELD
PA1519902OtherGATEWAY
PA03202300OtherCAPITAL BLUE CROSS
PA1583098OtherPA BLUE SHIELD