Provider Demographics
NPI:1497887988
Name:GREEN HILLS FAMILY MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:GREEN HILLS FAMILY MEDICAL ASSOCIATES, LLC
Other - Org Name:GREEN HILLS FAMILY MEDICINE ASSOC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BONACCORSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-777-4040
Mailing Address - Street 1:1903 MORGANTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19607
Mailing Address - Country:US
Mailing Address - Phone:610-777-4040
Mailing Address - Fax:610-777-5575
Practice Address - Street 1:1903 MORGANTOWN ROAD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607
Practice Address - Country:US
Practice Address - Phone:610-777-4040
Practice Address - Fax:610-777-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2010-01-04
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
PA023276Medicare UPIN