Provider Demographics
NPI:1477760684
Name:ST MARY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST MARY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MEDICAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-710-2009
Mailing Address - Street 1:1557 WILLOW POND DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5793
Mailing Address - Country:US
Mailing Address - Phone:215-493-9059
Mailing Address - Fax:215-710-5052
Practice Address - Street 1:1201 LANGHORNE NEWTOWN RD
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1201
Practice Address - Country:US
Practice Address - Phone:215-710-5744
Practice Address - Fax:215-710-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003582B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty