Provider Demographics
NPI:1790881001
Name:NESHAMINY MEDICAL PC
Entity Type:Organization
Organization Name:NESHAMINY MEDICAL PC
Other - Org Name:RICHBORO FAMIY MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:KENNY
Authorized Official - Last Name:RADBILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-757-1533
Mailing Address - Street 1:2426 BRISTOL ROAD
Mailing Address - Street 2:NESHAMINY VALLEY COMMONS
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020
Mailing Address - Country:US
Mailing Address - Phone:215-757-1533
Mailing Address - Fax:215-752-2402
Practice Address - Street 1:2426 BRISTOL ROAD
Practice Address - Street 2:NESHAMINY VALLEY COMMONS
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020
Practice Address - Country:US
Practice Address - Phone:215-757-1533
Practice Address - Fax:215-752-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0651441Medicaid