| Organization Name: | CARLOS FONSECA MEDICAL CENTER PC |
| NPI Number: | 1720404999 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | UTA ANGELA NOLLER (BUSINESS MANAGER) |
| Mailing Address: | 526 Penn St Reading |
| State: | PA US |
| Postal Code: | 196021096 |
| Phone Number: | 6103753000 |
| Fax Number: | 6103728030 |
| NPI Enumeration Date: | 03/12/2014 |
| NPI Last Update Date: | 03/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD006646E |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |