Provider Demographics
NPI:1376723643
Name:SOUTHEASTERN PENNSYLVANIA UROLOGIC SURGERY, P.C.
Entity Type:Organization
Organization Name:SOUTHEASTERN PENNSYLVANIA UROLOGIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIUSANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-869-6851
Mailing Address - Street 1:1011 W BALTIMORE PIKE
Mailing Address - Street 2:STE 312
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9446
Mailing Address - Country:US
Mailing Address - Phone:510-869-6851
Mailing Address - Fax:
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:STE 312
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9446
Practice Address - Country:US
Practice Address - Phone:510-869-6851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2070420000OtherKEYSTONE HPE
PAP484619OtherOXFORD
PA0015965780009Medicaid
PA1378803OtherPA BLUE SHIELD
PA340019880OtherRAIL ROAD MEDICARE
PA1039444OtherMERCY HEALTH PLAN
PA2070420000OtherKEYSTONE HPE