Healthcare Provider Details

I. General information

NPI: 1982120366
Provider Name (Legal Business Name): MERCY MANAGEMENT OF SEPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

IV. Provider business mailing address

1 W ELM ST
CONSHOHOCKEN PA
19428-4108
US

V. Phone/Fax

Practice location:
  • Phone: 610-237-4370
  • Fax: 610-234-5051
Mailing address:
  • Phone: 610-567-6964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMIEE BRENNAN
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 610-567-6964