=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790192441
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRYN MAWR MEDICAL SPECIALISTS ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2014
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 955 E HAVERFORD ROAD SUITE 300
-----------------------------------------------------
City | BRYN MAWR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-525-2990
-----------------------------------------------------
Fax | 610-525-2099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 825 OLD LANCASTER RD STE 320
-----------------------------------------------------
City | BRYN MAWR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19010-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-527-3800
-----------------------------------------------------
Fax | 610-527-0334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOE DESILVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-527-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------