Healthcare Provider Details

I. General information

NPI: 1952829350
Provider Name (Legal Business Name): THE CENTERS FOR ADVANCED UROLOGY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W GERMANTOWN PIKE STE 250
PLYMOUTH MEETING PA
19462-1421
US

IV. Provider business mailing address

140 W GERMANTOWN PIKE STE 250
PLYMOUTH MEETING PA
19462-1421
US

V. Phone/Fax

Practice location:
  • Phone: 484-530-0205
  • Fax: 484-530-0209
Mailing address:
  • Phone: 484-530-0205
  • Fax: 484-530-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J HAGG
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 484-530-0205