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General NPI Number Information
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NPI Number | 1396869012
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Entity Type | Organization
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Legal Business Name | WESTERN MAIN LINE UROLOGY PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 255 W LANCASTER AVE SUITE 333
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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 | 610-644-9600
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Fax | 610-644-0804
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Provider Business Mailing Address
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Address Line | 255 W LANCASTER AVE SUITE 333
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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 | 610-644-9600
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Fax | 610-644-0804
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY M THOMPSON
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Credential | MD
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Telephone | 610-644-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD04339E
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License Number State | PA
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