The Modern Country Doctor, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

THE MODERN COUNTRY DOCTOR, LLC

Practice address

23 Industrial Blvd Ste D
Paoli, PA 19301-1601

Phone

(610) 890-8522

Fax

(484) 568-4748

NPI assigned

May 15, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dennis Faith, MDNPI 1770727216

Title

Owner

Phone

(610) 890-8522

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dennis Alan Faith, MD

  • Family Medicine Physician
  • State College, PA
  • NPI 1770727216
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589500800000",
    "number": "1225650930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 INDUSTRIAL BLVD STE D",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011601",
            "telephone_number": "610-890-8522",
            "fax_number": "484-568-4748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 INDUSTRIAL BLVD STE D",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011601",
            "telephone_number": "610-890-8522",
            "fax_number": "484-568-4748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MODERN COUNTRY DOCTOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-15",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A",
        "authorized_official_last_name": "FAITH",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-890-8522",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Paoli, PA
• Providers in Paoli, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.