Provider Demographics
NPI:1407919376
Name:DELAWARE COUNTY UROLOGICAL ASSOCIATES, LTD
Entity Type:Organization
Organization Name:DELAWARE COUNTY UROLOGICAL ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIRSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-874-6580
Mailing Address - Street 1:30 MEDICAL CENTER BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3995
Mailing Address - Country:US
Mailing Address - Phone:610-874-6580
Mailing Address - Fax:610-874-5504
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:STE 102
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013-3995
Practice Address - Country:US
Practice Address - Phone:610-874-6580
Practice Address - Fax:610-874-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00872255Medicaid
016921OtherAETNA
PA0031111000OtherKEYSTONE HEALTH PLAN EAST
E55435Medicare UPIN
0760160001Medicare NSC
PA00872255Medicaid