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George R Homa

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NPI Number Detailed Information

Provider Information:

Name: George R Homa
Gender: M
Provider License Number If Given: OS004152L

NPI Information:

NPI: 1316932890
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 7/28/2010

Provider Business Mailing Address:

Address: 1 W ELM ST SUITE 100
Conshohocken, PA 19428
Phone Number: 6105676967
Fax Number: 6105676955

Provider Business Practice Location Address:

Address: 700 DEKALB ST
Bridgeport, PA 19405
Phone Number: 6102776200
Fax Number: 6102773437

Provider Taxonomy:

Primary: 207Q00000X
Secondary (if any): 208D00000X
State: PA

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