Provider Demographics
NPI:1750407144
Name:RADNOR FAMILY PRACTICE PROFESSIONAL LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:RADNOR FAMILY PRACTICE PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCKLAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-688-8807
Mailing Address - Street 1:372 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3924
Mailing Address - Country:US
Mailing Address - Phone:610-688-8807
Mailing Address - Fax:
Practice Address - Street 1:372 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3924
Practice Address - Country:US
Practice Address - Phone:610-688-8807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADNOR FAMILY PRACTICE PROFESSIONAL LIMITED LIABILITY COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088023Medicare ID - Type Unspecified