Provider Demographics
NPI:1609034867
Name:COUNTY OF MONTGOMERY UROLOGY
Entity Type:Organization
Organization Name:COUNTY OF MONTGOMERY UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBLASE
Authorized Official - Suffix:
Authorized Official - Credentials:DON
Authorized Official - Phone:610-792-2224
Mailing Address - Street 1:1600 BLACK ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-3147
Mailing Address - Country:US
Mailing Address - Phone:610-792-2224
Mailing Address - Fax:
Practice Address - Street 1:1600 BLACK ROCK RD
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-3147
Practice Address - Country:US
Practice Address - Phone:610-792-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKHOUSE PROVIDENCE POINTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063803L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098438OtherPROVIDER
PA340017735OtherRAILROAD #
PAMD063803LOtherLICENSE
PAG86626Medicare UPIN
PA098438OtherPROVIDER