Provider Demographics
NPI:1538104898
Name:CENTER FOR UROLOGIC CARE OF THE MAIN LINE,LTD
Entity Type:Organization
Organization Name:CENTER FOR UROLOGIC CARE OF THE MAIN LINE,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-525-2515
Mailing Address - Street 1:245 S BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2221
Mailing Address - Country:US
Mailing Address - Phone:610-525-2515
Mailing Address - Fax:610-527-6586
Practice Address - Street 1:245 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2221
Practice Address - Country:US
Practice Address - Phone:610-525-2515
Practice Address - Fax:610-527-6586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0272950001Medicare NSC
PACL5766Medicare PIN
PA410773Medicare PIN