Provider Demographics
NPI:1073557682
Name:DELAWARE VALLEY ORTHOPEDIC & SPINE CENTER, PC
Entity Type:Organization
Organization Name:DELAWARE VALLEY ORTHOPEDIC & SPINE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR-CREDENTIAL
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-836-1508
Mailing Address - Street 1:585 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3718
Mailing Address - Country:US
Mailing Address - Phone:215-836-1508
Mailing Address - Fax:215-240-1167
Practice Address - Street 1:5600 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3232
Practice Address - Country:US
Practice Address - Phone:158-361-5082
Practice Address - Fax:215-240-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty