Provider Demographics
NPI:1366672164
Name:ADVANCED UROLOGY PC
Entity Type:Organization
Organization Name:ADVANCED UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEIDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-695-6106
Mailing Address - Street 1:11960 LIONESS WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5640
Mailing Address - Country:US
Mailing Address - Phone:303-695-6106
Mailing Address - Fax:303-695-1211
Practice Address - Street 1:100 KESTREL DR
Practice Address - Street 2:SUITE 05
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2060
Practice Address - Country:US
Practice Address - Phone:610-831-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA45D1093597291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory