Provider Demographics
NPI:1710176375
Name:MDTAUBNRPRPA LLC
Entity Type:Organization
Organization Name:MDTAUBNRPRPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:HEPLER
Authorized Official - Last Name:TAUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-755-7291
Mailing Address - Street 1:309 OLD KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3352
Mailing Address - Country:US
Mailing Address - Phone:610-755-7291
Mailing Address - Fax:610-518-7412
Practice Address - Street 1:114 WASHINGTON AVE
Practice Address - Street 2:BUILDING 2
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2951
Practice Address - Country:US
Practice Address - Phone:610-518-7411
Practice Address - Fax:610-518-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432914208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD432914OtherMEDICAL LICENCE