Basic Information
| Provider Information | |||||||||
| NPI: | 1891723235 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHESTER COUNTY OBGYN SERVICES | ||||||||
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| OtherOrganizationName: | CHESTER COUNTY OBGYN ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 E MARSHALL ST | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193804441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106923434 | ||||||||
| FaxNumber: | 6106920265 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 E MARSHALL ST | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193804441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106923434 | ||||||||
| FaxNumber: | 6106920265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SPAHR | ||||||||
| AuthorizedOfficialFirstName: | TOM | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6106923434 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 0019069750001 | 05 | PA | MEDICAID |