Provider Demographics
NPI:1194121459
Name:AGGIE MD WHOLISTIC DOCTOR LLC
Entity type:Organization
Organization Name:AGGIE MD WHOLISTIC DOCTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-506-4874
Mailing Address - Street 1:50 FLINTLOCK LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5634
Mailing Address - Country:US
Mailing Address - Phone:610-506-4874
Mailing Address - Fax:215-881-9700
Practice Address - Street 1:50 FLINTLOCK LN
Practice Address - Street 2:
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087-5634
Practice Address - Country:US
Practice Address - Phone:610-506-4874
Practice Address - Fax:215-881-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty