Provider Demographics
NPI:1073677597
Name:PAOLI MEDICAL CONSULTANTS LLC
Entity Type:Organization
Organization Name:PAOLI MEDICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLIE
Authorized Official - Middle Name:GINA
Authorized Official - Last Name:STADLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-648-9330
Mailing Address - Street 1:21 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1610
Mailing Address - Country:US
Mailing Address - Phone:610-648-9330
Mailing Address - Fax:
Practice Address - Street 1:21 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1610
Practice Address - Country:US
Practice Address - Phone:610-648-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD04708L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
725110Medicare ID - Type Unspecified
PAF29265Medicare UPIN