Provider Demographics
NPI:1306815048
Name:GREAT VALLEY MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:GREAT VALLEY MEDICAL ASSOCIATES, PC
Other - Org Name:GREAT VALLEY MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOIGT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-9456
Mailing Address - Street 1:255 W LANCASTER AVE
Mailing Address - Street 2:MOB 2 SUITE 120
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1755
Mailing Address - Country:US
Mailing Address - Phone:610-644-9456
Mailing Address - Fax:610-644-5203
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:MOB 2 SUITE 120
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1755
Practice Address - Country:US
Practice Address - Phone:610-644-9456
Practice Address - Fax:610-644-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
050116OtherMEDICARE