Provider Demographics
NPI:1376544478
Name:UROLOGIC SURGEONS, INC.
Entity Type:Organization
Organization Name:UROLOGIC SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:BART
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-613-9251
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-0686
Mailing Address - Country:US
Mailing Address - Phone:610-613-9251
Mailing Address - Fax:
Practice Address - Street 1:525 JAMESTOWN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1751
Practice Address - Country:US
Practice Address - Phone:215-247-3082
Practice Address - Fax:215-247-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025287E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA767220Medicare PIN