Provider Demographics
NPI:1124200886
Name:LANGHORNE PHYSICAN SERVICES
Entity Type:Organization
Organization Name:LANGHORNE PHYSICAN SERVICES
Other - Org Name:MERCY ORTHOPEDIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, REGIONAL FINANCIAL REPORTING
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:FANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-886-6674
Mailing Address - Street 1:41 UNIVERSITY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2821 ISLAND AVE
Practice Address - Street 2:SUITE 147
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-2300
Practice Address - Country:US
Practice Address - Phone:610-626-9800
Practice Address - Fax:610-626-8856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1893659OtherHIGHMARK BLUE SHIELD
PA1007787930170Medicaid
PA1007787930170Medicaid