Basic Information
| Provider Information | |||||||||
| NPI: | 1215030812 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROY M LERMAN MD PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MAIN LINE SPINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 S HENDERSON RD | ||||||||
| Address2: | STE 308C | ||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103373111 | ||||||||
| FaxNumber: | 6103373506 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 S HENDERSON RD | ||||||||
| Address2: | STE 308C | ||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103373111 | ||||||||
| FaxNumber: | 6103373506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 11/28/2012 | ||||||||
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| AuthorizedOfficialLastName: | LERMAN | ||||||||
| AuthorizedOfficialFirstName: | ROY | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6103373111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0065074000 | 01 | PA | KEYSTONE HPE | OTHER | 1078604 | 01 | PA | KEYSTONE MERCY | OTHER | 260646 | 01 | PA | BCBS PERSONAL CHOICE | OTHER |