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General NPI Number Information
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NPI Number | 1174089858
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Entity Type | Organization
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Legal Business Name | CENTERS FOR ADVANCED UROLOGY, LLC
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Dates
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Enumeration Date | 02/18/2019
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Last Update Date | 02/18/2019
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Provider Practice Location Address
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Address Line | 400 DAVIS DR STE 200A
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1718
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Country | US
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Telephone | 610-825-2151
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Fax |
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Provider Business Mailing Address
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Address Line | 400 DAVIS DR STE 200A
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1718
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL PHYSICIAN
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Name | DAVID J ELLIS
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Credential |
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Telephone | 610-525-6580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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