Provider Demographics
NPI:1366400509
Name:NAZARETH AREA FAMILY MEDICINE ASSOCIATES PC
Entity type:Organization
Organization Name:NAZARETH AREA FAMILY MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:POGODZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-759-1200
Mailing Address - Street 1:25 S BROAD ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2255
Mailing Address - Country:US
Mailing Address - Phone:610-759-1200
Mailing Address - Fax:610-759-4590
Practice Address - Street 1:25 S BROAD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2255
Practice Address - Country:US
Practice Address - Phone:610-759-1200
Practice Address - Fax:610-759-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
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
PA072691Medicare ID - Type UnspecifiedGROUP