Provider Demographics
NPI:1447600416
Name:POTTSTOWN AMBULATORY CENTER, LLC
Entity Type:Organization
Organization Name:POTTSTOWN AMBULATORY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BURHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-542-9542
Mailing Address - Street 1:20 N SUNNYBROOK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-2946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 N SUNNYBROOK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464
Practice Address - Country:US
Practice Address - Phone:484-374-2600
Practice Address - Fax:484-752-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA24621501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical