Provider Demographics
NPI:1598010787
Name:CROZER CHESTER MEDICAL CENTER
Entity Type:Organization
Organization Name:CROZER CHESTER MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-447-7612
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:ACP 332
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-447-7612
Mailing Address - Fax:610-447-7615
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:ACP 332
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-447-7612
Practice Address - Fax:610-447-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT202484261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center