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NPI Code Detail

MEDICARE: UROLOGIC SURGERY, PC

MEDICARE: UROLOGIC SURGERY, PC
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
1208800000XUrology PhysicianOS003582LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619972965
Entity Type Code : Organization
Provider Name (Legal Business Name) : UROLOGIC SURGERY, PC
Provider Business Mailing Address
First Line : 301 E CITY AVE
Second Line : STE 210
City : BALA CYNWYD
State : PA
Zip : 19004-1734
Country : US
Telephone Number : 610-667-3020
Fax Number : 610-667-1817
Provider Business Practice Location Address
First Line : 301 E CITY AVE
Second Line : STE 210
City : BALA CYNWYD
State : PA
Zip : 19004-1734
Country : US
Telephone Number : 610-667-3020
Fax Number : 610-667-1817
Authorized Official
Title or Position : OFFCE MANAGER
Name : NANCY MILLER
Credential :
Telephone Number : 610-667-3021
Provider Enumeration Date : 06/14/2005
Last Update Date : 08/22/2020

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