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General NPI Number Information
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NPI Number | 1316919368
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Entity Type | Organization
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Legal Business Name | MAIN LINE EMERGENCY MED ASSOCIATES LLC
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 255 W LANCASTER AVE
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City | PAOLI
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State | PA
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Zip | 19301-1763
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Country | US
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Telephone | 610-648-1043
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Fax | 610-648-1415
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Provider Business Mailing Address
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Address Line | PO BOX 415751
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City | BOSTON
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State | MA
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Zip | 02241-5751
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Country | US
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Telephone | 866-960-6774
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN J GAMBURG
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Credential | MD
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Telephone | 800-456-4629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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