Healthcare Provider Details

I. General information

NPI: 1013200955
Provider Name (Legal Business Name): TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 WOODBOURNE RD STE 101
LEVITTOWN PA
19057-1520
US

IV. Provider business mailing address

41 UNIVERSITY DR STE 300
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 215-945-1500
  • Fax: 215-752-8022
Mailing address:
  • Phone: 734-343-2654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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