Provider Demographics
NPI:1568459121
Name:NORTHWESTERN MEDICAL CENTER PC
Entity Type:Organization
Organization Name:NORTHWESTERN MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:D
Authorized Official - Last Name:VERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-298-8521
Mailing Address - Street 1:7096 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:NEW TRIPOLI
Mailing Address - State:PA
Mailing Address - Zip Code:18066-3815
Mailing Address - Country:US
Mailing Address - Phone:610-298-8521
Mailing Address - Fax:610-298-3021
Practice Address - Street 1:7096 DECATUR ST
Practice Address - Street 2:
Practice Address - City:NEW TRIPOLI
Practice Address - State:PA
Practice Address - Zip Code:18066-3815
Practice Address - Country:US
Practice Address - Phone:610-298-8521
Practice Address - Fax:610-298-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
448479Medicare ID - Type Unspecified