Provider Demographics
NPI:1679043152
Name:PREVENTION POINT PHILADELPHIA
Entity Type:Organization
Organization Name:PREVENTION POINT PHILADELPHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:BARCLAY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:609-505-9287
Mailing Address - Street 1:2913-15 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-3016
Mailing Address - Country:US
Mailing Address - Phone:609-505-9287
Mailing Address - Fax:
Practice Address - Street 1:2913-15 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-3016
Practice Address - Country:US
Practice Address - Phone:609-505-9287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty