Healthcare Provider Details

I. General information

NPI: 1568720803
Provider Name (Legal Business Name): TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 LANGHORNE NEWTOWN RD STE 108
LANGHORNE PA
19047-1219
US

IV. Provider business mailing address

41 UNIVERSITY DR STE 300
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 215-710-2444
  • Fax: 215-710-6007
Mailing address:
  • Phone: 734-343-2654
  • Fax: 215-710-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE KEESE
Title or Position: VP, FINANCE AND CFO
Credential:
Phone: 301-754-7201