Provider Demographics
NPI:1619920147
Name:INTERNAL MEDICINE ASSOCIATES OF WEST READING
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF WEST READING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:LE
Authorized Official - Last Name:WILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-376-8169
Mailing Address - Street 1:310 S 7TH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1415
Mailing Address - Country:US
Mailing Address - Phone:610-376-8169
Mailing Address - Fax:610-376-0164
Practice Address - Street 1:310 S 7TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1415
Practice Address - Country:US
Practice Address - Phone:610-376-8169
Practice Address - Fax:610-376-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
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
PA129165Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER