Provider Demographics
NPI:1598724742
Name:PAOLI INTERNAL MEDICINE ASSOCIATES PC
Entity Type:Organization
Organization Name:PAOLI INTERNAL MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCANANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-647-8885
Mailing Address - Street 1:255 W LANCASTER AVE
Mailing Address - Street 2:121 PAOLI MOB II
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1763
Mailing Address - Country:US
Mailing Address - Phone:610-647-8885
Mailing Address - Fax:610-640-3832
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:121 PAOLI MOB II
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:610-647-8885
Practice Address - Fax:610-640-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACH9113OtherRAILROAD MEDICARE
PA0012275740003Medicaid
PA051298Medicare PIN
PA0012275740003Medicaid