Provider Demographics
NPI:1437104460
Name:MAIN LINE ALLERGY , L.L.P.
Entity Type:Organization
Organization Name:MAIN LINE ALLERGY , L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTHVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WODELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-642-1643
Mailing Address - Street 1:233 E LANCASTER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2321
Mailing Address - Country:US
Mailing Address - Phone:610-642-1643
Mailing Address - Fax:
Practice Address - Street 1:233 E LANCASTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2321
Practice Address - Country:US
Practice Address - Phone:610-642-1643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA194748OtherHIGHMARK PIN
PA194748Medicare PIN