Provider Demographics
NPI:1033276076
Name:MEDICAL ASSOCIATES OF THE MAIN LINE, PC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF THE MAIN LINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:HORWICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-596-7860
Mailing Address - Street 1:PO BOX 19498
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4089
Mailing Address - Country:US
Mailing Address - Phone:484-596-5254
Mailing Address - Fax:484-596-5404
Practice Address - Street 1:414 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3311
Practice Address - Country:US
Practice Address - Phone:610-640-3943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000421902Medicaid
PA001245376Medicaid
6675325Medicare ID - Type Unspecified