Provider Demographics
NPI:1427002112
Name:ABINGTON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ABINGTON MEMORIAL HOSPITAL
Other - Org Name:GLENSIDE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-481-2600
Mailing Address - Street 1:678 OLD YORK ROAD
Mailing Address - Street 2:NORTH COURT
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046
Mailing Address - Country:US
Mailing Address - Phone:215-885-4733
Mailing Address - Fax:215-885-4573
Practice Address - Street 1:678 OLD YORK ROAD
Practice Address - Street 2:NORTH COURT
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:215-885-4733
Practice Address - Fax:215-885-4573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA006035Medicare PIN