Provider Demographics
NPI:1619213865
Name:EAST PENN MEDICAL CENTER
Entity Type:Organization
Organization Name:EAST PENN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-928-1150
Mailing Address - Street 1:1003 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-1902
Mailing Address - Country:US
Mailing Address - Phone:610-928-1150
Mailing Address - Fax:610-625-2314
Practice Address - Street 1:1003 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-1902
Practice Address - Country:US
Practice Address - Phone:610-928-1150
Practice Address - Fax:610-625-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
183915OtherMEDICARE PTAN
692103OtherMEDICARE PTAN
PA0016773350004Medicaid
PA0016773350004Medicaid