Provider Demographics
NPI:1386783603
Name:EVELYN R. RUNER, M.D., FACE, LLC
Entity type:Organization
Organization Name:EVELYN R. RUNER, M.D., FACE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:ROSARIO
Authorized Official - Last Name:RUNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-741-4016
Mailing Address - Street 1:333 N. OXFORD VALLEY RD.
Mailing Address - Street 2:SUITE 404
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030
Mailing Address - Country:US
Mailing Address - Phone:215-741-4016
Mailing Address - Fax:215-741-4019
Practice Address - Street 1:333 N. OXFORD VALLEY RD.
Practice Address - Street 2:SUITE 404
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030
Practice Address - Country:US
Practice Address - Phone:215-741-4016
Practice Address - Fax:215-741-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064046L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019408500003Medicaid
PA031067Medicare PIN
PAH02737Medicare UPIN