Provider Demographics
NPI:1497700363
Name:PHILADELPHIA UROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:PHILADELPHIA UROLOGY ASSOCIATES PC
Other - Org Name:PHILADELPHIA UROLOGY ASSOCIATES, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-563-1199
Mailing Address - Street 1:1015 CHESTNUT ST STE 405
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4304
Mailing Address - Country:US
Mailing Address - Phone:215-563-1199
Mailing Address - Fax:215-563-1783
Practice Address - Street 1:1015 CHESTNUT ST STE 405
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4304
Practice Address - Country:US
Practice Address - Phone:215-563-1199
Practice Address - Fax:215-563-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA170270Medicare ID - Type UnspecifiedGROUP PROVIDER#