Basic Information
| Provider Information | |||||||||
| NPI: | 1376988410 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREAT VALLEY OBGYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 THOMAS JONES WAY | ||||||||
| Address2: | MAIN LINE HEALTH CTR SUITE 210 | ||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193412553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845658550 | ||||||||
| FaxNumber: | 6102801569 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 THOMAS JONES WAY | ||||||||
| Address2: | MAIN LINE HEALTH CTR SUITE 210 | ||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193412553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845658550 | ||||||||
| FaxNumber: | 6102801569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2013 | ||||||||
| LastUpdateDate: | 05/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | COLDREN | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4845658550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.