Provider Demographics
NPI:1093279739
Name:ADVOCARE , LLC
Entity Type:Organization
Organization Name:ADVOCARE , LLC
Other - Org Name:ADVOCARE NEWTOWN SQUARE INTERNAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VP AND COO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-872-7055
Mailing Address - Street 1:PO BOX 71422
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19176-1422
Mailing Address - Country:US
Mailing Address - Phone:856-872-7055
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:3475 W CHESTER PIKE STE 235
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4291
Practice Address - Country:US
Practice Address - Phone:610-265-9290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-28
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty