Provider Demographics
NPI:1528012101
Name:DOCTORS TELEHEALTH NETWORK, INC
Entity Type:Organization
Organization Name:DOCTORS TELEHEALTH NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-553-0887
Mailing Address - Street 1:2028 QUAIL ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2220
Mailing Address - Country:US
Mailing Address - Phone:949-553-0887
Mailing Address - Fax:775-417-7154
Practice Address - Street 1:703 S ELMER AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2400
Practice Address - Country:US
Practice Address - Phone:949-553-0887
Practice Address - Fax:775-417-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092377UDQMedicare ID - Type Unspecified