Healthcare Provider Details

I. General information

NPI: 1245263250
Provider Name (Legal Business Name): ALAN LOWELL MEZEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE SUITE 210
WYNNEWOOD PA
19096-3448
US

IV. Provider business mailing address

100 LANCASTER AVE SUITE 210
WYNNEWOOD PA
19096-3448
US

V. Phone/Fax

Practice location:
  • Phone: 610-649-1515
  • Fax: 610-649-9564
Mailing address:
  • Phone: 610-649-1515
  • Fax: 610-649-9564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD045026L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD045026L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: