Healthcare Provider Details

I. General information

NPI: 1689020026
Provider Name (Legal Business Name): TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4595 NEW FALLS RD SUITE A
LEVITTOWN PA
19056
US

IV. Provider business mailing address

41 UNIVERSITY DR SUITE 300
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 267-587-3700
  • Fax: 215-949-2650
Mailing address:
  • Phone: 215-710-5522
  • Fax: 215-710-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON PROFERA
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 215-710-2013