Provider Demographics
NPI:1457487209
Name:PENNDEL MEDICAL PRACTICE LLC
Entity Type:Organization
Organization Name:PENNDEL MEDICAL PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PERRONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:267-852-2110
Mailing Address - Street 1:447 WOODBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-4300
Mailing Address - Country:US
Mailing Address - Phone:267-852-2110
Mailing Address - Fax:267-852-2114
Practice Address - Street 1:447 WOODBOURNE RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-4300
Practice Address - Country:US
Practice Address - Phone:267-852-2110
Practice Address - Fax:267-852-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005077L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty