Provider Demographics
NPI:1548079965
Name:CORE FAMILY PRACTICE
Entity type:Organization
Organization Name:CORE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HAUG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-694-0475
Mailing Address - Street 1:1786 WILMINGTON W CHESTER PIKE STE 202A
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-8198
Mailing Address - Country:US
Mailing Address - Phone:610-557-8903
Mailing Address - Fax:610-486-3019
Practice Address - Street 1:1786 WILMINGTON W CHESTER PIKE STE 202A
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-8198
Practice Address - Country:US
Practice Address - Phone:610-557-8903
Practice Address - Fax:610-486-3019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORE FAMILY PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty