Healthcare Provider Details

I. General information

NPI: 1598755340
Provider Name (Legal Business Name): MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 PROVIDENCE RD
SECANE PA
19018-2921
US

IV. Provider business mailing address

1 W ELM ST 2ND FLOOR
CONSHOHOCKEN PA
19428-2007
US

V. Phone/Fax

Practice location:
  • Phone: 610-934-1234
  • Fax: 610-934-4811
Mailing address:
  • Phone: 610-567-6964
  • Fax: 610-567-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS C SMITH
Title or Position: VP FINANCIAL SERVICES
Credential:
Phone: 610-567-6964