Provider Demographics
NPI:1730848425
Name:RADNOR FAMILY PRACTICE, PLLC, DBA IM HEALTH
Entity type:Organization
Organization Name:RADNOR FAMILY PRACTICE, PLLC, DBA IM HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-688-8807
Mailing Address - Street 1:372 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:372 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3924
Practice Address - Country:US
Practice Address - Phone:610-688-8807
Practice Address - Fax:610-688-2970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADNOR FAMILY PRACTICE, PLLC, DBA IM HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-10
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty