Provider Demographics
NPI:1558415877
Name:BETHLEHEM PRIMARY CARE PROVIDERS PC
Entity Type:Organization
Organization Name:BETHLEHEM PRIMARY CARE PROVIDERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-691-2282
Mailing Address - Street 1:3445 HIGH POINT BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7812
Mailing Address - Country:US
Mailing Address - Phone:610-691-2282
Mailing Address - Fax:610-691-2410
Practice Address - Street 1:3445 HIGH POINT BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7812
Practice Address - Country:US
Practice Address - Phone:610-691-2282
Practice Address - Fax:610-691-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010000-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA129924OtherHIGHMARK
PA02348900OtherCAPITAL BLUE CROSS
PA2685643OtherAETNA
PAH13246Medicare UPIN
PA057799Medicare ID - Type Unspecified