Provider Demographics
NPI:1003860966
Name:BRYN MAWR UROLOGY
Entity Type:Organization
Organization Name:BRYN MAWR UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-525-6580
Mailing Address - Street 1:919 CONESTOGA RD
Mailing Address - Street 2:BUILDING ONE SUITE 300
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-525-6580
Mailing Address - Fax:610-525-3664
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BUILDING ONE SUITE 300
Practice Address - City:ROSEMONT
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-525-6580
Practice Address - Fax:610-525-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA852775Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER