| The Modern Country Doctor, LLC | |
|
23 Industrial Blvd Ste D Paoli PA 19301-1601 | |
| (610) 890-8522 | |
| (484) 568-4748 |
| Full Name | The Modern Country Doctor, LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 23 Industrial Blvd Ste D, Paoli, Pennsylvania |
| Authorized Official Name and Position | Dennis Faith (OWNER) |
| Authorized Official Contact | 6108908522 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Modern Country Doctor, LLC 23 Industrial Blvd Ste D Paoli PA 19301-1601 Ph: (610) 890-8522 | The Modern Country Doctor, LLC 23 Industrial Blvd Ste D Paoli PA 19301-1601 Ph: (610) 890-8522 |
| NPI Number | 1225650930 |
|---|---|
| Provider Enumeration Date | 05/15/2020 |
| Last Update Date | 05/15/2020 |
| Certification Date | 05/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225650930 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 261Q00000X | Clinic/center | () | Secondary |
| 261QR1300X | Clinic/center - Rural Health | () | Secondary |
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