Provider Demographics
NPI:1992873764
Name:JAMES W. PADGET III & SONIA M PADGET PTR
Entity type:Organization
Organization Name:JAMES W. PADGET III & SONIA M PADGET PTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:PADGET
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:610-337-3195
Mailing Address - Street 1:491 ALLENDALE RD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1426
Mailing Address - Country:US
Mailing Address - Phone:610-337-3195
Mailing Address - Fax:610-337-0932
Practice Address - Street 1:491 ALLENDALE RD
Practice Address - Street 2:SUITE 313
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1426
Practice Address - Country:US
Practice Address - Phone:610-337-3195
Practice Address - Fax:610-337-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014548E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070531Medicare PIN