Provider Demographics
NPI:1619014933
Name:GWYNEDD FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:GWYNEDD FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:S
Authorized Official - Last Name:FISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-997-9737
Mailing Address - Street 1:1600 HORIZON DR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-4100
Mailing Address - Country:US
Mailing Address - Phone:215-997-9737
Mailing Address - Fax:215-997-9738
Practice Address - Street 1:1600 HORIZON DR
Practice Address - Street 2:SUITE 117
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-4100
Practice Address - Country:US
Practice Address - Phone:215-997-9737
Practice Address - Fax:215-997-9738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty