Provider Demographics
NPI:1134195688
Name:DETWEILER FAMILY MEDICINE & ASSO
Entity type:Organization
Organization Name:DETWEILER FAMILY MEDICINE & ASSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:O
Authorized Official - Last Name:DETWEILER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-868-1900
Mailing Address - Street 1:1970 NORTH BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446
Mailing Address - Country:US
Mailing Address - Phone:215-368-1900
Mailing Address - Fax:215-368-8772
Practice Address - Street 1:1970 NORTH BROAD STREET
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446
Practice Address - Country:US
Practice Address - Phone:215-368-1900
Practice Address - Fax:215-368-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty