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General NPI Number Information
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NPI Number | 1790742187
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Entity Type | Organization
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Legal Business Name | MAIN LINE SURGEONS, LTD.
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 E LANCASTER AVE MEDICAL SCIENCE BLDG. SUITE 275
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3450
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Country | US
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Telephone | 610-642-1908
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E LANCASTER AVE MEDICAL SCIENCE BLDG. SUITE 275
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3450
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Country | US
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Telephone | 610-642-1908
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. BRIAN TRIPLETT
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Credential | RN MPH
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Telephone | 610-642-1908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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