THE MODERN COUNTRY DOCTOR, LLC (NPI# 1225650930) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225650930 |
| Entity Type | Organization |
| Organization Name | THE MODERN COUNTRY DOCTOR, LLC |
| Practice Address |
23 Industrial Blvd Ste D Paoli PA 19301-1601 |
| Practice Telephone | 6108908522 |
| Practice Fax Number | 4845684748 |
| Mailing Telephone | 6108908522 |
| Mailing Fax Number | 4845684748 |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2020-05-15 |
| Authorized Official Name | DR. DENNIS FAITH (OWNER) |
| Authorized Official Telephone | 6108908522 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| N | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
23 INDUSTRIAL BLVD STE D |
| City | PAOLI |
| State | PA |
| Zip Code | 19301-1601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588280333 | Mary Callery | Physical Therapy Assistant | 16 Industrial Blvd., Ste. 101, Paoli, PA 19301 | 2020-06-17 |
| 1871097519 | Daniel Malloy-good | Social Worker | 45 Darby Rd Ste E4, Paoli, PA 19301 | 2018-03-19 |
| 1306354774 | Patricia Obilo-azandegbe | Counselor | 30 S Valley Rd Ste 101, Paoli, PA 19301 | 2018-01-18 |
| 1275992877 | Jessica Bernard | Physical Therapist | 40 Darby Rd Ste 1, Paoli, PA 19301 | 2016-02-11 |
| 1730576364 | Ushma Sheth | Podiatrist | 250 W Lancaster Ave Ste 225, Paoli, PA 19301 | 2015-04-21 |
| 1619371432 | Miriam Leslie Brewer | Physical Therapist | 195 W Lancaster Ave #3, Paoli, PA 19301 | 2014-10-22 |
| 1447665393 | Matthew Rementer | Podiatrist | 254 West Lancaster Ave, Paoli, PA 19301 | 2014-06-29 |
| 1720490915 | Edward Anthony Romero | Surgery | 255 W Lancaster Ave Ste 332, Paoli, PA 19301 | 2014-05-22 |
| 1285053421 | Jose Ethan Pulido | Urology | 2 Industrial Blvd Bldg C Ste 120, Paoli, PA 19301 | 2014-04-15 |
| 1093065849 | Kathleen M Canfield | Physician Assistant | 11 Industrial Blvd., Ste 204, Paoli Pointe Med. Office Bldg, Paoli, PA 19301 | 2012-09-19 |
| Find all providers in zip 19301 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083855514 | George T Taylor Iv | Family Medicine | 250 W Lancaster Ave Ste 120, Paoli, PA 19301-1798 | 2009-03-12 |
| 1730298746 | Yolanda Joy Yoder | Family Medicine | 420 W Longest St, Paoli, IN 47454-8821 | 2006-08-30 |
| 1245282235 | Paoli Family Medicine | Family Medicine | 250 Lancaster Ave, Suite 120, Paoli, PA 19301 | 2006-05-17 |
| 1548233083 | Barry Herbert Burkhardt | Family Medicine | 209 W Lancaster Ave, Suite 101, Paoli, PA 19301-1749 | 2006-02-07 |
| 1063490001 | Merlin W Friesen Iv | Family Medicine | 202 Cherry St, Paoli, IN 47454-1108 | 2006-01-09 |
| 1528555703 | Mackenzie Foster | Family Medicine | 250 W Lancaster Ave Ste 120, Paoli, PA 19301-1798 | 2018-04-13 |
| 1710349766 | Fyzah Hussain Qureshi | Family Medicine | 255 W Lancaster Ave, Paoli, PA 19301-1763 | 2016-03-28 |
| 1427430081 | Sergio S. Sales | Family Medicine | 642 W Hospital Rd, Paoli, IN 47454 | 2015-06-19 |
| 1952714040 | Jeffrey Cain Stevens | Family Medicine | 255 W Lancaster Ave Ste 330, Paoli, PA 19301-1766 | 2014-06-05 |
| 1306106836 | Timothy B Mack | Family Medicine | 255 W Lancaster Ave Ste 330, Paoli, PA 19301-1766 | 2012-05-17 |
| Find all providers in PAOLI | ||||
Please comment or provide details below to improve the information on THE MODERN COUNTRY DOCTOR, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.