Provider Demographics
NPI:1578774725
Name:ARTHRITIS ASSOCIATES OF THE MAIN LINE, PC
Entity Type:Organization
Organization Name:ARTHRITIS ASSOCIATES OF THE MAIN LINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-647-2398
Mailing Address - Street 1:11 INDUSTRIAL BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301
Mailing Address - Country:US
Mailing Address - Phone:610-647-2398
Mailing Address - Fax:610-993-2867
Practice Address - Street 1:11 INDUSTRIAL BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-647-2398
Practice Address - Fax:610-993-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA012059E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty