Provider Demographics
NPI:1558889956
Name:CENTERS FOR ADVANCED UROLOGY, LLP
Entity Type:Organization
Organization Name:CENTERS FOR ADVANCED UROLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-530-0205
Mailing Address - Street 1:1 PRESIDENTIAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1015
Mailing Address - Country:US
Mailing Address - Phone:610-632-4100
Mailing Address - Fax:610-668-1067
Practice Address - Street 1:1 PRESIDENTIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1015
Practice Address - Country:US
Practice Address - Phone:610-632-4100
Practice Address - Fax:610-668-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty