Provider Demographics
NPI:1598971251
Name:MUA ASSOCIATES OF PENNSYLVANIA
Entity Type:Organization
Organization Name:MUA ASSOCIATES OF PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:THOEDORE
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:DC RCRD FABCS FRCCM
Authorized Official - Phone:717-355-2940
Mailing Address - Street 1:4605 DIVISION HWY
Mailing Address - Street 2:
Mailing Address - City:EAST EARL
Mailing Address - State:PA
Mailing Address - Zip Code:17519
Mailing Address - Country:US
Mailing Address - Phone:717-355-2940
Mailing Address - Fax:717-355-2940
Practice Address - Street 1:4605 DIVISION HWY
Practice Address - Street 2:
Practice Address - City:EAST EARL
Practice Address - State:PA
Practice Address - Zip Code:17519
Practice Address - Country:US
Practice Address - Phone:717-355-2940
Practice Address - Fax:717-355-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1699148OtherHIGHMARK BLUE SHIELD