Healthcare Provider Details

I. General information

NPI: 1295214492
Provider Name (Legal Business Name): MAIN LINE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 E LANCASTER AVE STE 200
WYNNEWOOD PA
19096
US

IV. Provider business mailing address

3803 W CHESTER PIKE STE 160
NEWTOWN SQUARE PA
19073-2336
US

V. Phone/Fax

Practice location:
  • Phone: 484-565-1293
  • Fax: 484-476-7855
Mailing address:
  • Phone: 484-337-1585
  • Fax: 484-337-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StatePA

VIII. Authorized Official

Name: MICHELLE SNYDER
Title or Position: MANAGER
Credential:
Phone: 484-337-1585