MEDICARE: NORTHEASTERN UROLOGICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CM5670	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06897	OTHER	PA	HEALTH PARTNERS
2	076967	OTHER	PA	BLUE CROSS PA
3	32522	OTHER	PW	KEYSTONE MERCY
4	0053477000	OTHER	PW	KEYSTONE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255366605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEASTERN UROLOGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	2314 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4432
Country	:	US
Telephone Number	:	215-634-2900
Fax Number	:	215-634-5687

Provider Business Practice Location Address
First Line	:	2314 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4432
Country	:	US
Telephone Number	:	215-634-2900
Fax Number	:	215-634-5687

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAWRENCE SOLISH
Credential	:	MD
Telephone Number	:	215-634-2900

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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Directions to “NORTHEASTERN UROLOGICAL ASSOCIATES ” Practice Location

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