Healthcare Provider Details

I. General information

NPI: 1053303347
Provider Name (Legal Business Name): ORTHOPAEDIC SURGERY & SPORTS MEDICINE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 W LANCASTER AVE
PAOLI PA
19301-1723
US

IV. Provider business mailing address

PO BOX 968
PAOLI PA
19301-0968
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-7755
  • Fax: 610-644-8290
Mailing address:
  • Phone: 610-644-7755
  • Fax: 610-644-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LEWIS S SHARPS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 610-644-7755