Healthcare Provider Details

I. General information

NPI: 1578222758
Provider Name (Legal Business Name): BMMSA HEART & VASCULAR CENTER OF THE MAIN LINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 E HAVERFORD RD STE 100
BRYN MAWR PA
19010-3868
US

IV. Provider business mailing address

955 E HAVERFORD RD STE 100
BRYN MAWR PA
19010-3868
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-3800
  • Fax: 610-527-0334
Mailing address:
  • Phone: 610-527-3800
  • Fax: 610-527-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE DESILVA
Title or Position: CEO
Credential:
Phone: 610-527-3800