Provider Demographics
NPI:1346262359
Name:PENNRIDGE OBGYN ASSOCIATES
Entity Type:Organization
Organization Name:PENNRIDGE OBGYN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:VIZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-257-1193
Mailing Address - Street 1:920 LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1560
Mailing Address - Country:US
Mailing Address - Phone:215-257-1193
Mailing Address - Fax:215-257-0307
Practice Address - Street 1:920 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1560
Practice Address - Country:US
Practice Address - Phone:215-257-1193
Practice Address - Fax:215-257-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0021897000OtherKEYSTONE HEALTH PLAN EAST