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General NPI Number Information
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NPI Number | 1609161207
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Entity Type | Organization
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Legal Business Name | UROLOGIC CONSULTANTS OF SOUTHEASTERN PENNSYLVANIA, LLP
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 1 PRESIDENTIAL BLVD STE 100
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1017
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Country | US
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Telephone | 610-667-3020
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Fax | 610-667-1817
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Provider Business Mailing Address
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Address Line | 1 PRESIDENTIAL BLVD STE 100
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1017
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Country | US
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Telephone | 610-667-3020
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Fax | 610-667-1817
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | NANCY P MILLER
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Credential |
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Telephone | 610-667-3020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State | PA
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