Provider Demographics
NPI:1003017534
Name:ROY M LERMAN MD PC
Entity Type:Organization
Organization Name:ROY M LERMAN MD PC
Other - Org Name:MAIN LINE SPINE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-337-3111
Mailing Address - Street 1:700 S HENDERSON RD
Mailing Address - Street 2:STE 308C
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406
Mailing Address - Country:US
Mailing Address - Phone:610-337-3111
Mailing Address - Fax:610-337-3506
Practice Address - Street 1:700 S HENDERSON RD
Practice Address - Street 2:STE 300A
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406
Practice Address - Country:US
Practice Address - Phone:610-337-0427
Practice Address - Fax:610-337-3506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROY M LERMAN MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-31
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA777323OtherBLUE SHIELD HIGHMARK