Provider Demographics
NPI:1972550564
Name:FAMILY MEDICINE ASSOCIATES OF BIRDSBORO, PC
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF BIRDSBORO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-582-5300
Mailing Address - Street 1:321 N FURNACE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-2057
Mailing Address - Country:US
Mailing Address - Phone:610-582-5300
Mailing Address - Fax:610-582-1464
Practice Address - Street 1:321 N FURNACE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-2057
Practice Address - Country:US
Practice Address - Phone:610-582-5300
Practice Address - Fax:610-582-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
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
PA02327500OtherCAPITAL BLUE CROSS
PA421487OtherBLUE SHIELD
PA421487OtherBLUE SHIELD