Provider Demographics
NPI:1144386822
Name:PENNSYLVANIA REPRODUCTIVE ASSOCIATES
Entity Type:Organization
Organization Name:PENNSYLVANIA REPRODUCTIVE ASSOCIATES
Other - Org Name:WOMENS INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-834-1230
Mailing Address - Street 1:815 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5504
Mailing Address - Country:US
Mailing Address - Phone:215-922-2206
Mailing Address - Fax:
Practice Address - Street 1:815 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5504
Practice Address - Country:US
Practice Address - Phone:215-922-2206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty