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General NPI Number Information
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NPI Number | 1578774725
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Entity Type | Organization
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Legal Business Name | ARTHRITIS ASSOCIATES OF THE MAIN LINE, PC
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Dates
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Enumeration Date | 05/26/2007
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 11 INDUSTRIAL BLVD. SUITE 201
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City | PAOLI
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State | PA
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Zip | 19301
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Country | US
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Telephone | 610-647-2398
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Fax | 610-993-2867
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Provider Business Mailing Address
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Address Line | 11 INDUSTRIAL BLVD. SUITE 201
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City | PAOLI
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State | PA
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Zip | 19301
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Country | US
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Telephone | 610-647-2398
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Fax | 610-993-2867
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. KIMBERLY SMALLWOOD
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Credential |
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Telephone | 610-647-2398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 012059E
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License Number State | PA
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