Provider Demographics
NPI:1578658928
Name:PEACE VALLEY INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:PEACE VALLEY INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-230-8380
Mailing Address - Street 1:5039 SWAMP ROAD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FOUNTAINVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18923-9667
Mailing Address - Country:US
Mailing Address - Phone:215-230-8380
Mailing Address - Fax:215-230-8370
Practice Address - Street 1:5039 SWAMP ROAD
Practice Address - Street 2:SUITE 401
Practice Address - City:FOUNTAINVILLE
Practice Address - State:PA
Practice Address - Zip Code:18923-9667
Practice Address - Country:US
Practice Address - Phone:215-230-8380
Practice Address - Fax:215-230-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
045742Medicare ID - Type Unspecified