Provider Demographics
NPI:1437548047
Name:SOUTHEAST PENNSYLVANIA SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHEAST PENNSYLVANIA SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-583-6721
Mailing Address - Street 1:1501 LANSDOWNE AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1333
Mailing Address - Country:US
Mailing Address - Phone:610-534-6210
Mailing Address - Fax:610-534-6209
Practice Address - Street 1:1501 LANSDOWNE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1333
Practice Address - Country:US
Practice Address - Phone:610-534-6210
Practice Address - Fax:610-534-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA044074Medicare PIN