Basic Information
| Provider Information | |||||||||
| NPI: | 1598216533 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRYN MAWR MEDICAL SPECIALISTS ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 OLD LANCASTER RD STE 320 | ||||||||
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| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190103235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105273800 | ||||||||
| FaxNumber: | 6105270608 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 OLD LANCASTER RD STE 420 | ||||||||
| Address2: | |||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190103236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105208887 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2016 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | MILITELLO | ||||||||
| AuthorizedOfficialFirstName: | RUSS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6105273800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.