Provider Demographics
NPI:1376918334
Name:EMG URGENT CARE 6787 MARKET ST
Entity Type:Organization
Organization Name:EMG URGENT CARE 6787 MARKET ST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GUOFANG
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-812-5752
Mailing Address - Street 1:23 MOUNT AIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-3356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6787 MARKET ST
Practice Address - Street 2:SUITE # 4
Practice Address - City:MILLBOURNE
Practice Address - State:PA
Practice Address - Zip Code:19082-1848
Practice Address - Country:US
Practice Address - Phone:610-812-5752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437798146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA350468Medicare PIN