Provider Demographics
NPI:1053547182
Name:WE CARE MEDICAL GROUP PC
Entity type:Organization
Organization Name:WE CARE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GENNADIY
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-631-3873
Mailing Address - Street 1:520 BUSTLETON PIKE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6052
Mailing Address - Country:US
Mailing Address - Phone:215-631-3873
Mailing Address - Fax:215-631-3899
Practice Address - Street 1:520 BUSTLETON PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6052
Practice Address - Country:US
Practice Address - Phone:215-631-3873
Practice Address - Fax:215-631-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty