Provider Demographics
NPI:1497192942
Name:MAINLINE HEALTHCARE BRYN MAWR FAMILY PRACTICE
Entity Type:Organization
Organization Name:MAINLINE HEALTHCARE BRYN MAWR FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANU
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:484-883-6168
Mailing Address - Street 1:409 CHARLES LANE
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:484-883-6168
Mailing Address - Fax:
Practice Address - Street 1:1991 SPROUL ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008
Practice Address - Country:US
Practice Address - Phone:610-325-1390
Practice Address - Fax:610-325-1373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015430282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital