1982910931 NPI number — TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP

Table of content: (NPI 1982910931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982910931 NPI number — TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THMA MG PRIMARY CARE WOODBOURNE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982910931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 UNIVERSITY DRIVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18940-1873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-710-5522
Provider Business Mailing Address Fax Number:
215-710-5181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1609 WOODBOURNE RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEVITTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-945-1500
Provider Business Practice Location Address Fax Number:
215-945-9192
Provider Enumeration Date:
08/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CLARKE
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
REGIONAL VP
Authorized Official Telephone Number:
215-710-6542

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS006458E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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