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General NPI Number Information
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NPI Number | 1326455072
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Entity Type | Organization
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Legal Business Name | BRYN MAWR MEDICAL SPECIALISTS ASSOCIATION
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 937 E HAVERFORD RD SUITE 103
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City | BRYN MAWR
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State | PA
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Zip | 19010-3800
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Country | US
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Telephone | 610-527-8844
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Fax | 610-527-6658
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Provider Business Mailing Address
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Address Line | 825 OLD LANCASTER RD STE 320
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City | BRYN MAWR
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State | PA
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Zip | 19010-3231
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Country | US
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Telephone | 610-527-3800
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Fax | 610-527-0334
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Authorized Official
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Title or Position | CEO
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Name | RUSS J MILITELLO
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Credential |
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Telephone | 610-527-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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