Provider Demographics
NPI:1003206608
Name:URBAN COMMUNITY PHYSICIAN ADVISORY BOARD LLC
Entity Type:Organization
Organization Name:URBAN COMMUNITY PHYSICIAN ADVISORY BOARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-966-1546
Mailing Address - Street 1:722 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3503
Mailing Address - Country:US
Mailing Address - Phone:610-622-9953
Mailing Address - Fax:610-284-6540
Practice Address - Street 1:722 CHURCH LN
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3503
Practice Address - Country:US
Practice Address - Phone:610-622-9953
Practice Address - Fax:610-284-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 261QP2300X
PAMD080525L261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10397151001Medicaid
PAF93932Medicare UPIN