Provider Demographics
NPI:1568047546
Name:PHYSICIANS MEDICAL WEIGHT LOSS, LLC
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL WEIGHT LOSS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONORATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-962-3373
Mailing Address - Street 1:163 N COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8933
Mailing Address - Country:US
Mailing Address - Phone:610-867-7246
Mailing Address - Fax:
Practice Address - Street 1:5245 GERMANTOWN AVE STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2328
Practice Address - Country:US
Practice Address - Phone:484-222-3087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty