Healthcare Provider Details

I. General information

NPI: 1073557682
Provider Name (Legal Business Name): DELAWARE VALLEY ORTHOPEDIC & SPINE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/28/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 CHESTNUT ST
PHILADELPHIA PA
19139-3232
US

IV. Provider business mailing address

585 COUNTY LINE RD
RADNOR PA
19087-3718
US

V. Phone/Fax

Practice location:
  • Phone: 158-361-5082
  • Fax: 215-240-1677
Mailing address:
  • Phone: 215-836-1508
  • Fax: 215-240-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StatePA

VIII. Authorized Official

Name: MISS MARY ANNE SUTER
Title or Position: HR-CREDENTIAL
Credential:
Phone: 215-836-1508