Basic Information
| Provider Information | |||||||||
| NPI: | 1336440700 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LANKENAU MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 514 SHARPLESS ST | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193823541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106920754 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 LANCASTER AVE | ||||||||
| Address2: | SUITE 418 LANKENAU MEDICAL CENTER | ||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4844768464 | ||||||||
| FaxNumber: | 4844761626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2010 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | MORTON | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | ALFRED | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 6106920754 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | P.A.-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | MA000079L | PA | Y | Hospitals | General Acute Care Hospital |
No ID Information.