Provider Demographics
NPI:1376988410
Name:GREAT VALLEY OBGYN
Entity Type:Organization
Organization Name:GREAT VALLEY OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLDREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-565-8550
Mailing Address - Street 1:495 THOMAS JONES WAY
Mailing Address - Street 2:MAIN LINE HEALTH CTR SUITE 210
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2553
Mailing Address - Country:US
Mailing Address - Phone:484-565-8550
Mailing Address - Fax:610-280-1569
Practice Address - Street 1:495 THOMAS JONES WAY
Practice Address - Street 2:MAIN LINE HEALTH CTR SUITE 210
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2553
Practice Address - Country:US
Practice Address - Phone:484-565-8550
Practice Address - Fax:610-280-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty