Provider Demographics
NPI:1275541153
Name:VALLEY FORGE URGENT CARE & FAMILY MED CTR
Entity Type:Organization
Organization Name:VALLEY FORGE URGENT CARE & FAMILY MED CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAHAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MDPC
Authorized Official - Phone:610-539-3221
Mailing Address - Street 1:2521 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3093
Mailing Address - Country:US
Mailing Address - Phone:610-539-3221
Mailing Address - Fax:610-539-3222
Practice Address - Street 1:2521 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19403-3093
Practice Address - Country:US
Practice Address - Phone:610-539-3221
Practice Address - Fax:610-539-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020142E207Q00000X
PAMD060296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0599136Medicaid
PA0599136Medicaid
B34614Medicare UPIN