Provider Demographics
NPI:1407347396
Name:CENTERS FOR ADVANCED UROLOGY, LLP
Entity Type:Organization
Organization Name:CENTERS FOR ADVANCED UROLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SERAFINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-382-5917
Mailing Address - Street 1:211 S GULPH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3101
Mailing Address - Country:US
Mailing Address - Phone:610-382-5910
Mailing Address - Fax:610-382-5918
Practice Address - Street 1:919 CONESTOGA RD STE 300
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-382-5910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTERS FOR ADVANCED UROLOGY, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-25
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty