=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356278899
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRYN MAWR MEDICAL SPECIALISTS ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2026
-----------------------------------------------------
Last Update Date | 05/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 CLARK AVE STE 17B
-----------------------------------------------------
City | KING OF PRUSSIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19406-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-836-1656
-----------------------------------------------------
Fax | 610-672-0302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 CLARK AVE STE 17B
-----------------------------------------------------
City | KING OF PRUSSIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19406-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-836-1656
-----------------------------------------------------
Fax | 610-672-0302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | ANDREW WAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-527-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------