Healthcare Provider Details

I. General information

NPI: 1689620254
Provider Name (Legal Business Name): CLINICAL RENAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL CENTER BLVD SUITE 303
UPLAND PA
19013-3955
US

IV. Provider business mailing address

850 W RIO SALADO PKWY STE 201
TEMPE AZ
85281-3812
US

V. Phone/Fax

Practice location:
  • Phone: 610-872-8501
  • Fax: 610-872-5188
Mailing address:
  • Phone: 480-480-8330
  • Fax: 480-610-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROY G. MARCUS
Title or Position: CHIEF OPERATING OFFICER
Credential: M.D.
Phone: 610-872-8501