Basic Information
| Provider Information | |||||||||
| NPI: | 1033558671 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LANKENAU MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 CITY AVE | ||||||||
| Address2: | APT 4803 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191311500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126802900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 E LANCASTER AVE | ||||||||
| Address2: | MOB S SUITE 422 | ||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190963450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4844762169 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2013 | ||||||||
| LastUpdateDate: | 06/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | UKANI | ||||||||
| AuthorizedOfficialFirstName: | GOPI | ||||||||
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| AuthorizedOfficialTitleorPosition: | SURGICAL RESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4126802900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | MT205197 | PA | Y | Hospitals | General Acute Care Hospital |
No ID Information.