Provider Demographics
NPI:1083721088
Name:CHESTER COUNTY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:CHESTER COUNTY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GIUNTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-269-8155
Mailing Address - Street 1:797 E LANCASTER AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3315
Mailing Address - Country:US
Mailing Address - Phone:610-269-8155
Mailing Address - Fax:610-269-9557
Practice Address - Street 1:797 E LANCASTER AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3315
Practice Address - Country:US
Practice Address - Phone:610-269-8155
Practice Address - Fax:610-269-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA41772OtherPA BLUE SHIELD
PA00687711Medicaid
PA1090538OtherKEYSTONE MERCY
PA1090538OtherKEYSTONE MERCY
PA044548Medicare ID - Type Unspecified