Provider Demographics
NPI:1215030812
Name:ROY M LERMAN MD PC
Entity Type:Organization
Organization Name:ROY M LERMAN MD PC
Other - Org Name:MAIN LINE SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-337-3111
Mailing Address - Street 1:700 S HENDERSON RD
Mailing Address - Street 2:STE 308C
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406
Mailing Address - Country:US
Mailing Address - Phone:610-337-3111
Mailing Address - Fax:610-337-3506
Practice Address - Street 1:700 S HENDERSON RD
Practice Address - Street 2:STE 308C
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406
Practice Address - Country:US
Practice Address - Phone:610-337-3111
Practice Address - Fax:610-337-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0065074000OtherKEYSTONE HPE
PA1078604OtherKEYSTONE MERCY
PA260646OtherBCBS PERSONAL CHOICE
014790MFFMedicare ID - Type Unspecified