Basic Information
| Provider Information | |||||||||
| NPI: | 1497192942 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAINLINE HEALTHCARE BRYN MAWR FAMILY PRACTICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 CHARLES LANE | ||||||||
| Address2: | |||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848836168 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1991 SPROUL ROAD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BROOMALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103251390 | ||||||||
| FaxNumber: | 6103251373 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2013 | ||||||||
| LastUpdateDate: | 05/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | RAMDAS | ||||||||
| AuthorizedOfficialFirstName: | ANU | ||||||||
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| AuthorizedOfficialTitleorPosition: | RESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4848836168 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | OT015430 | PA | Y | Hospitals | General Acute Care Hospital |
No ID Information.