Provider Demographics
NPI:1699796599
Name:FAMILY MEDICINE SPECIALISTS
Entity type:Organization
Organization Name:FAMILY MEDICINE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:DENITZIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-869-9220
Mailing Address - Street 1:308 E BALTIMORE PIKE
Mailing Address - Street 2:P.O. BOX 189
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9261
Mailing Address - Country:US
Mailing Address - Phone:610-869-9220
Mailing Address - Fax:610-869-5555
Practice Address - Street 1:308 E BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9261
Practice Address - Country:US
Practice Address - Phone:610-869-9220
Practice Address - Fax:610-869-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD074447261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAA72234Medicare UPIN
PA057288QJSMedicare ID - Type Unspecified