Basic Information
| Provider Information | |||||||||
| NPI: | 1326455072 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRYN MAWR MEDICAL SPECIALISTS ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 OLD LANCASTER RD | ||||||||
| Address2: | STE 320 | ||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190103231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105273800 | ||||||||
| FaxNumber: | 6105270334 | ||||||||
| Practice Location | |||||||||
| Address1: | 937 E HAVERFORD RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190103800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105278844 | ||||||||
| FaxNumber: | 6105276658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2014 | ||||||||
| LastUpdateDate: | 07/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | MILITELLO | ||||||||
| AuthorizedOfficialFirstName: | RUSS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6105273800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.