Provider Demographics
NPI:1477501559
Name:MARY-ANNE OST MD LTD
Entity Type:Organization
Organization Name:MARY-ANNE OST MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY-ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:OST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-869-0311
Mailing Address - Street 1:1 COMMERCE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9198
Mailing Address - Country:US
Mailing Address - Phone:610-869-0311
Mailing Address - Fax:610-869-0333
Practice Address - Street 1:1 COMMERCE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9198
Practice Address - Country:US
Practice Address - Phone:610-869-0311
Practice Address - Fax:610-869-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1190896OtherCIGNA
4076312OtherAETNA
002823997OtherPERSONAL CHOICE
414114ZPEVMedicare PIN