Provider Demographics
NPI:1417060922
Name:LESTER J. GROVERMAN,M.D.&ROBERT J. BRAUNFELD,D.O.ASSOCIATES,P.A.
Entity Type:Organization
Organization Name:LESTER J. GROVERMAN,M.D.&ROBERT J. BRAUNFELD,D.O.ASSOCIATES,P.A.
Other - Org Name:DELAWARE COUNTY FAMILY PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-353-3500
Mailing Address - Street 1:2000 SPROUL RD SUITE 100
Mailing Address - Street 2:MARPLE COMMONS
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-2424
Mailing Address - Country:US
Mailing Address - Phone:610-353-3500
Mailing Address - Fax:610-353-2015
Practice Address - Street 1:2000 SPROUL RD SUITE 100
Practice Address - Street 2:MARPLE COMMONS
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-2424
Practice Address - Country:US
Practice Address - Phone:610-353-3500
Practice Address - Fax:610-353-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA135920OtherMEDICARE RR
PA0005387OtherAETNA
PA0032084001OtherIBC PRODUCTS
PA0032084001OtherKEYSTONE
PA0008557190006Medicaid
PA135920OtherPA BLUE SHIELD
PA30025952OtherKEYSTONE MERCY
PA0005387OtherAETNA