Provider Demographics
NPI:1003176488
Name:TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Entity Type:Organization
Organization Name:TRINITY HEALTH MID-ATLANTIC MEDICAL GROUP
Other - Org Name:THE BARIATRIC AND METABOLIC SURGERY PROGRAM AT ST.MARY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN DIR OF FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PROFERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-710-2013
Mailing Address - Street 1:41 UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:201-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:1205 LANGHRN NWTWN RD STE 310
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-710-5711
Practice Address - Fax:215-710-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty